EMCrit Blog - Emergency Department Critical Care http://emcrit.org Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation Thu, 28 Aug 2014 23:00:16 +0000 en-US hourly 1 http://wordpress.org/?v=3.9.2 http://emcrit.org/feed/podcast/ Help me fill in the blanks of the practice of ED Critical Care. In this podcast, we discuss all things related to the crashing, critically ill patient in the Emergency Department. Find the show notes at emcrit.org. Scott D. Weingart, MD clean Scott D. Weingart, MD spam.bin55REMOVE@gmail.com spam.bin55REMOVE@gmail.com (Scott D. Weingart, MD) 2009-2013 Online Medical Education on Emergency Department (ED) Critical Care, Trauma, & Resuscitation emergency, critical care, emergency critical care, intensive care, intensivist, emergency medicine, emergency department, ICU, trauma EMCrit Blog - Emergency Department Critical Care http://emcrit.org/wp-content/uploads/powerpress/rssimageart.png http://emcrit.org EMCrit Podcast 131 – Cut to Air: Surgical Airway from SMACC Gold http://emcrit.org/podcasts/surgical-airway/ http://emcrit.org/podcasts/surgical-airway/#comments Tue, 26 Aug 2014 20:57:27 +0000 http://emcrit.org/?p=10806 Cut to Air: Crics from SMACC Gold

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http://emcrit.org/podcasts/surgical-airway/feed/ 3 featured,smacc Cut to Air: Crics from SMACC Gold Cut to Air: Crics from SMACC Gold Scott D. Weingart, MD clean 29:51 yes
EMCrit Wee – A Case to Threaten Current ECMO Evidence from Sam G http://emcrit.org/wee/prolonged-cpr-case/ http://emcrit.org/wee/prolonged-cpr-case/#comments Fri, 15 Aug 2014 14:35:53 +0000 http://emcrit.org/?p=7951 Should we be extending ACLS in patients we really want to save?

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http://emcrit.org/wee/prolonged-cpr-case/feed/ 20 Should we be extending ACLS in patients we really want to save? Should we be extending ACLS in patients we really want to save? Scott D. Weingart, MD clean 5:44
Table-of-Contents and FOAMcc in One Bolus http://emcrit.org/blogpost/journal-opml/ http://emcrit.org/blogpost/journal-opml/#comments Tue, 12 Aug 2014 16:12:11 +0000 http://emcrit.org/?p=10612 All the journal goodness

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EMCrit Podcast 130 – Hemodynamic-Directed Dosing of Epinephrine for Cardiac Arrest http://emcrit.org/podcasts/hemodynamic-directed-dosing-epinephrine/ http://emcrit.org/podcasts/hemodynamic-directed-dosing-epinephrine/#comments Sun, 10 Aug 2014 19:22:21 +0000 http://emcrit.org/?p=9761 Today on the podcast, I address the last little bit from my SMACC lecture on the new management of the intra-arrest: hemodynamic, individualized dosing of epinephrine.

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http://emcrit.org/podcasts/hemodynamic-directed-dosing-epinephrine/feed/ 32 featured,Norman Paradis Today on the podcast, I address the last little bit from my SMACC lecture on the new management of the intra-arrest: hemodynamic, individualized dosing of epinephrine. Today on the podcast, I address the last little bit from my SMACC lecture on the new management of the intra-arrest: hemodynamic, individualized dosing of epinephrine. Scott D. Weingart, MD clean 18:24
Ebola Diagnosis and Treatment http://emcrit.org/blogpost/ebola-diagnosis-treatment/ http://emcrit.org/blogpost/ebola-diagnosis-treatment/#comments Sat, 09 Aug 2014 00:52:16 +0000 http://emcrit.org/?p=10576 Just in Case...

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MotR – Mike Lauria on “Making the Call” http://emcrit.org/podcasts/motr-mike-lauria/ http://emcrit.org/podcasts/motr-mike-lauria/#comments Thu, 31 Jul 2014 13:26:47 +0000 http://emcrit.org/?p=10394 You'll be hearing more from Mike

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http://emcrit.org/podcasts/motr-mike-lauria/feed/ 6 Mind of the Resuscitationist You'll be hearing more from Mike You'll be hearing more from Mike Scott D. Weingart, MD clean 42:52
Podcast 129 – LAMW: The Neurocritical Care Intubation http://emcrit.org/podcasts/neurocritical-care-intubation/ http://emcrit.org/podcasts/neurocritical-care-intubation/#comments Sat, 26 Jul 2014 16:36:12 +0000 http://emcrit.org/?p=4458 This is the another of the Laryngoscope as a Murder Weapon lectures; though in this case it is really more of an aggravated assault.

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http://emcrit.org/podcasts/neurocritical-care-intubation/feed/ 12 featured,LAMW This is the another of the Laryngoscope as a Murder Weapon lectures; though in this case it is really more of an aggravated assault. This is the another of the Laryngoscope as a Murder Weapon lectures; though in this case it is really more of an aggravated assault. Scott D. Weingart, MD clean 31:00
2 Pitches http://emcrit.org/misc/2-pitches/ http://emcrit.org/misc/2-pitches/#comments Fri, 25 Jul 2014 02:14:37 +0000 http://emcrit.org/?p=10363 Airway Course and Neurocritical Care Course

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Podcast 128 – Pulmonary Embolism Treatment Options and the PEAC Team with Oren Friedman http://emcrit.org/podcasts/pulmonary-embolism-treatment-team/ http://emcrit.org/podcasts/pulmonary-embolism-treatment-team/#comments Mon, 14 Jul 2014 14:24:33 +0000 http://emcrit.org/?p=9513 We now have way too many treatment options for sub-massive and massive pulmonary embolism (PE) patients who aren’t coding in front of you. How do you decide which one is right for your patient? To help answer this question, I am joined today by Oren Friedman, pulmonary critical care doc and one of the members […]

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http://emcrit.org/podcasts/pulmonary-embolism-treatment-team/feed/ 5 expert-commentary,featured,Oren Friedman We now have way too many treatment options for sub-massive and massive pulmonary embolism (PE) patients who aren't coding in front of you. How do you decide which one is right for your patient? To help answer this question, We now have way too many treatment options for sub-massive and massive pulmonary embolism (PE) patients who aren't coding in front of you. How do you decide which one is right for your patient? To help answer this question, I am joined today by Oren Friedman, pulmonary critical care doc and one of the members of the Cornell PEAC team. Cornell Pulmonary Embolism (PE) Advanced Care Team (PEAC), aka the CLOT Team Oren Friedman MD, Pulm Crit Care; James Horowitz MD, Cardiology; Arash Salemi MD, Cardiac Surgery; Akhilesh Sista MD, Interventional Radiology You can shoot the team an email: peadvancedcare at gmail dot com Who Should We Treat? 30% normotensive patients have RVD; 10% progressed to shock; 5% in hospital mortality The Better Risk Categories for Pulmonary Embolism Well and Stable Sub-Massive High-Risk Sub-Massive Massive PEITHO Trial NEJM 2014;370(15):1402 Full dose tenecteplase with concurrent heparin Death or hemodynamic decompensation occurred in 2.6% of the tenecteplase group as compared with 5.6% of the placebo group Extracranial bleeding occurred in 32 patients (6.3%) in the tenecteplase group and 6 patients (1.2%) in the placebo group (P<0.001) Intracranial Bleed 10 patients (2%) in the tenecteplase group and 1 patient (0.2%) in the placebo group (P=0.003) Also see my bud, Salim Rezaie's post on PEITHO and Konstantinides' prior study Ryan Radecki made some great observations in his post on PEITHO The criteria for myocardial injury was a troponin I >0.06 ?g/L or troponin T >0.01 ?g/L.  These may be relatively inclusive thresholds. Not all placebo patients developing hemodynamic collapse received subsequent thrombolysis; likewise, almost half of those who received open-label thrombolysis had no hemodynamic collapse. Half the deaths in the placebo arm were “sudden unexplained” or “other”, compared with bleeding or stroke complications in the thromboysis arm. TOPCOAT Trial Jeff Kline's trial was stopped midway through due to an institution change. Complicated primary endpoint with promising, but unusable results For the scoop on this one see the Bottom Line Review post on TOPCOAT MOPETT Trial Half-dose alteplase led to a marked reduction in pulmonary hypertension without sig. complications Sharifi M et al. Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT trial). (J Cardiol 2013; 111: 273) See this prior EMCrit Wee as well on MOPPETT Update: This meta-analysis states that the half-dose may be appropriate, effective, and safe Meta-Analysis Chatterjee et al. have the most current meta-analysis on this topic (JAMA. 2014;311(23):2414-2421) See the Bottom Line Review post on this study Nakamura just published another MA this week; see Rory Spiegel's take on the two here Is it just in the Oldies? Markedly lower risk in <75 y/o in PEITHO and <65 in the Meta-Analysis The Treatment Options Heparin Alone tried and true. but even if some degree of resolution of presenting severe symptoms, there is the question of long-term consequences of leaving a large clot burden--namely, loss of exercise tolerance due to chronic pulmonary hypertension Systemic Thrombolysis With either full or half-dose alteplase or full-dose tenecteplase Catheter-Based Intra-Arterial Thombolytic Infusion Angiography guided placement of pulmonary artery catheters allowing a 24-hour infusion of low dose tPA. A newer therapy is the EKOS catheter. This uses ultrasound to continuously break up the clot during the IA Thrombolysis. Many of us wonder if this is any better than standard catheter-based therapy. , See the PulmCCM Post on the Circulation RCT of EKOS Interventional Mechanical Clot Disruption AngioJet-a catheter that breaks up the clot with a high speed jet of saline, heparin, or tPA that then sucks up clot using Bernoulli physics. Very little systemic drug is delivered. Oren's center doesn't like the device; other centers use it. Scott D. Weingart, MD clean 33:08
Expert Commentary on EMCrit http://emcrit.org/blogpost/expert-commentary/ http://emcrit.org/blogpost/expert-commentary/#comments Sun, 06 Jul 2014 19:43:01 +0000 http://emcrit.org/?p=10127 What this icon means

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Are you Following Jeff Kline’s Twitter Account http://emcrit.org/blogpost/following-jeff-klines-twitter-account/ http://emcrit.org/blogpost/following-jeff-klines-twitter-account/#comments Sun, 06 Jul 2014 17:49:09 +0000 http://emcrit.org/?p=10113 Jeff Kline is on twitter

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Podcast 127 – The Oxylator with Jim DuCanto http://emcrit.org/podcasts/oxylator/ http://emcrit.org/podcasts/oxylator/#comments Sun, 29 Jun 2014 19:15:45 +0000 http://emcrit.org/?p=3881 BVMs are ridiculously crappy and downright dangerous. The solution? the Oxylator

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http://emcrit.org/podcasts/oxylator/feed/ 20 featured,Jim DuCanto BVMs are ridiculously crappy and downright dangerous. The solution? the Oxylator BVMs are ridiculously crappy and downright dangerous. The solution? the Oxylator Scott D. Weingart, MD clean 20:19
SMACC-Back – On the Beliefs of Early Adopters and Straw Men http://emcrit.org/wee/on-the-beliefs-adopters-straw-men/ http://emcrit.org/wee/on-the-beliefs-adopters-straw-men/#comments Tue, 24 Jun 2014 19:45:36 +0000 http://emcrit.org/?p=9899 The First SMACC-Back from SMACCgold

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http://emcrit.org/wee/on-the-beliefs-adopters-straw-men/feed/ 11 smacc-back The First SMACC-Back from SMACCgold The First SMACC-Back from SMACCgold Scott D. Weingart, MD clean 16:30
MOTR: Cliff Reid on When Should Stop Resuscitation http://emcrit.org/wee/cliff-reid-resuscitation-stop/ http://emcrit.org/wee/cliff-reid-resuscitation-stop/#comments Wed, 18 Jun 2014 23:39:14 +0000 http://emcrit.org/?p=9766 Cliff Reid on When Should Resus Stop from SMACCgold

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Podcast 126 – TTM Trial Right from Niklas Nielsen’s Mouth http://emcrit.org/podcasts/ttm-trial-niklas-nielsen/ http://emcrit.org/podcasts/ttm-trial-niklas-nielsen/#comments Sun, 15 Jun 2014 19:29:40 +0000 http://emcrit.org/?p=7745 In this episode, I speak with Niklas Nielsen on his thoughts on the TTM trial.

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http://emcrit.org/podcasts/ttm-trial-niklas-nielsen/feed/ 5 featured,Niklas Nielsen In this episode, I speak with Niklas Nielsen on his thoughts on the TTM trial. In this episode, I speak with Niklas Nielsen on his thoughts on the TTM trial. Scott D. Weingart, MD clean 18:09
EMCrit Wee – Four More Minutes with Rob Mac Sweeney http://emcrit.org/wee/rob-mac-sweeneys-stuff/ http://emcrit.org/wee/rob-mac-sweeneys-stuff/#respond Wed, 11 Jun 2014 17:45:26 +0000 http://emcrit.org/?p=9485 I told you today we would have a bit of discussion on Rob Mac Sweeney's FOAM. Well here it is...

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http://emcrit.org/wee/rob-mac-sweeneys-stuff/feed/ 0 I told you today we would have a bit of discussion on Rob Mac Sweeney's FOAM. Well here it is... I told you today we would have a bit of discussion on Rob Mac Sweeney's FOAM. Well here it is... Scott D. Weingart, MD clean 4:32
EMCrit Wee – Rob Mac Sweeney on Intra-Arrest Meds http://emcrit.org/wee/rob-mac-sweeney/ http://emcrit.org/wee/rob-mac-sweeney/#comments Tue, 10 Jun 2014 18:28:46 +0000 http://emcrit.org/?p=9471 Rob Mac Sweeny on the Intra-Arrest Talk

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http://emcrit.org/wee/rob-mac-sweeney/feed/ 18 Rob Mac Sweeny on the Intra-Arrest Talk Rob Mac Sweeny on the Intra-Arrest Talk Scott D. Weingart, MD clean 16:56
PEMED’s Resus Kit http://emcrit.org/blogpost/pemeds-resus-kit/ http://emcrit.org/blogpost/pemeds-resus-kit/#comments Sun, 08 Jun 2014 21:00:49 +0000 http://emcrit.org/?p=9432 Andrew Sloas of PEMED builds his resus pack

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Mind of the Resuscitationist – Errors of Commission and Omission http://emcrit.org/wee/motr-commission-and-omission/ http://emcrit.org/wee/motr-commission-and-omission/#comments Fri, 06 Jun 2014 18:20:58 +0000 http://emcrit.org/?p=9389 Should we err towards errors of commission or omission?

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http://emcrit.org/wee/motr-commission-and-omission/feed/ 83 Mind of the Resuscitationist Should we err towards errors of commission or omission? Should we err towards errors of commission or omission? Scott D. Weingart, MD clean 5:22
Podcast 125 – The New Intra-Arrest from SMACCgold http://emcrit.org/podcasts/new-intra-arrest/ http://emcrit.org/podcasts/new-intra-arrest/#comments Mon, 02 Jun 2014 15:59:28 +0000 http://emcrit.org/?p=9246 Enough with cook book medicine and courses for dermatologists--let's provide cutting edge intra-arrest care

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http://emcrit.org/podcasts/new-intra-arrest/feed/ 43 featured,smacc Enough with cook book medicine and courses for dermatologists--let's provide cutting edge intra-arrest care Enough with cook book medicine and courses for dermatologists--let's provide cutting edge intra-arrest care Scott D. Weingart, MD clean 21:11 yes
EMCrit Wee – Cricolol by Dr. John Hinds http://emcrit.org/wee/cricolol/ http://emcrit.org/wee/cricolol/#comments Wed, 28 May 2014 15:29:42 +0000 http://emcrit.org/?p=9170 My favorite part of SMACCgold; buy some Cricolol

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http://emcrit.org/wee/cricolol/feed/ 6 John Hinds,smacc My favorite part of SMACCgold; buy some Cricolol My favorite part of SMACCgold; buy some Cricolol Scott D. Weingart, MD clean 8:36 yes
Podcast 124 – The Logistics of Proning for ARDS http://emcrit.org/podcasts/logistics-proning/ http://emcrit.org/podcasts/logistics-proning/#comments Mon, 19 May 2014 00:10:08 +0000 http://emcrit.org/?p=8001 Proning is one of the only evidence-based techniques to affect the mortality of ARDS patients. I've been wanting to do an episode on proning for a while.

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http://emcrit.org/podcasts/logistics-proning/feed/ 12 featured,Joseph Tonna Proning is one of the only evidence-based techniques to affect the mortality of ARDS patients. I've been wanting to do an episode on proning for a while. Proning is one of the only evidence-based techniques to affect the mortality of ARDS patients. I've been wanting to do an episode on proning for a while. Scott D. Weingart, MD clean 23:21
EMCrit Wee – Sean Townsend of the SSC and the ProCESS Trial http://emcrit.org/wee/ssc-process-trial-response/ http://emcrit.org/wee/ssc-process-trial-response/#comments Fri, 09 May 2014 19:36:30 +0000 http://emcrit.org/?p=8239 I talk with a member of the surviving sepsis campaign steering committee re: ProCESS

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http://emcrit.org/wee/ssc-process-trial-response/feed/ 10 Sean Townsend I talk with a member of the surviving sepsis campaign steering committee re: ProCESS I talk with a member of the surviving sepsis campaign steering committee re: ProCESS Scott D. Weingart, MD clean 17:33
Podcast 123 – Selective Aortic Arch Perfusion (SAAP) with Jim Manning http://emcrit.org/podcasts/selective-aortic-arch-perfusion/ http://emcrit.org/podcasts/selective-aortic-arch-perfusion/#comments Tue, 06 May 2014 14:50:06 +0000 http://emcrit.org/?p=8441 What if you had a REBOA catheter through which you could give blood and drugs?

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http://emcrit.org/podcasts/selective-aortic-arch-perfusion/feed/ 5 featured,Jim Manning What if you had a REBOA catheter through which you could give blood and drugs? What if you had a REBOA catheter through which you could give blood and drugs? Scott D. Weingart, MD clean 28:31
My Reflections on #SMACCGold http://emcrit.org/misc/reflections-smaccgold/ http://emcrit.org/misc/reflections-smaccgold/#comments Tue, 29 Apr 2014 20:22:39 +0000 http://emcrit.org/?p=8300 well, actually not mine at all.

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In-Situ Sim http://emcrit.org/misc/situ-sim/ http://emcrit.org/misc/situ-sim/#comments Sat, 26 Apr 2014 16:46:20 +0000 http://emcrit.org/?p=8287 MobileSim Site

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EMCrit Wee – A Cric Case with Rob Bryant http://emcrit.org/wee/cric-case-rob-bryant/ http://emcrit.org/wee/cric-case-rob-bryant/#comments Thu, 24 Apr 2014 23:07:14 +0000 http://emcrit.org/?p=8147 Rob Bryant presents a case

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http://emcrit.org/wee/cric-case-rob-bryant/feed/ 16 Rob Bryant Rob Bryant presents a case Rob Bryant presents a case Scott D. Weingart, MD clean 12:12
Podcast 122 – Cardiac Arrest after the Toxicology of Smoke Inhalation with Lewis Nelson http://emcrit.org/podcasts/cardiac-arrest-after-smoke-inhalation/ http://emcrit.org/podcasts/cardiac-arrest-after-smoke-inhalation/#comments Mon, 21 Apr 2014 02:46:07 +0000 http://emcrit.org/?p=8131 What is the proper care for a patient in cardiac arrest or shock after smoke inhalation if they don't have severe burns?

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http://emcrit.org/podcasts/cardiac-arrest-after-smoke-inhalation/feed/ 16 featured,Lewis Nelson What is the proper care for a patient in cardiac arrest or shock after smoke inhalation if they don't have severe burns? What is the proper care for a patient in cardiac arrest or shock after smoke inhalation if they don't have severe burns? Scott D. Weingart, MD clean 18:01
150 Lives in 150 Days http://emcrit.org/misc/150-lives-150-days/ http://emcrit.org/misc/150-lives-150-days/#respond Fri, 11 Apr 2014 18:50:17 +0000 http://emcrit.org/?p=8006 Sepsis Collaboratives work in Canada too

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Which Airway Mannequin for Resuscitationists? http://emcrit.org/misc/airway-mannequin/ http://emcrit.org/misc/airway-mannequin/#comments Fri, 11 Apr 2014 15:34:35 +0000 http://emcrit.org/?p=7998 Who would know better than Minh Le Cong? He recommends this particular model from Nasco (as always neither of us have any COI). Nasco Critical Airway Manager Minh has beaten the crap our of his, drowned it, and basically committed levels of abuse that would get him arrested in a more civilized country. Also Checkout […]

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US Emergency Physicians Must Read this Piece http://emcrit.org/misc/gross-negligence/ http://emcrit.org/misc/gross-negligence/#comments Wed, 09 Apr 2014 19:36:12 +0000 http://emcrit.org/?p=7967 Gross Negligence?

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EMCrit Podcast 121 – REBOA http://emcrit.org/podcasts/reboa/ http://emcrit.org/podcasts/reboa/#comments Sun, 06 Apr 2014 19:05:12 +0000 http://emcrit.org/?p=7061 This episode, we discuss REBOA (resuscitative endovascular balloon occlusion of the aorta).

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http://emcrit.org/podcasts/reboa/feed/ 18 featured,Megan Brenner This episode, we discuss REBOA (resuscitative endovascular balloon occlusion of the aorta). This episode, we discuss REBOA (resuscitative endovascular balloon occlusion of the aorta). Scott D. Weingart, MD clean 20:31
Handwashing – Shakes and Bumps http://emcrit.org/blogpost/handwashing-shakes-bumps/ http://emcrit.org/blogpost/handwashing-shakes-bumps/#comments Tue, 25 Mar 2014 18:48:37 +0000 http://emcrit.org/?p=7740 No more handshakes!

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Podcast 120 – The ProCESS Trial with Derek Angus http://emcrit.org/podcasts/process-trial/ http://emcrit.org/podcasts/process-trial/#comments Mon, 24 Mar 2014 23:55:24 +0000 http://emcrit.org/?p=7717 I speak to the lead author of the ProCESS trial, Dr. Derek Angus

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http://emcrit.org/podcasts/process-trial/feed/ 34 Derek Angus,featured I speak to the lead author of the ProCESS trial, Dr. Derek Angus I speak to the lead author of the ProCESS trial, Dr. Derek Angus Scott D. Weingart, MD clean 25:35
Wee – What the heck is a Mapleson B Circuit and Why You Probably Shouldn’t Care http://emcrit.org/wee/what-the-heck-is-a-mapleson-b-circuitu-probably-shouldnt-care/ http://emcrit.org/wee/what-the-heck-is-a-mapleson-b-circuitu-probably-shouldnt-care/#comments Tue, 11 Mar 2014 21:47:14 +0000 http://emcrit.org/?p=6781 There is a really smart anesthesiologist out there called Nicholas Chrimes. He along with his mate Peter Fritz invented the Vortex Approach to Airway Management. He also runs a blog called Clinical CrEd. He did a post advocating the Mapleson B Circuit as the Ultimate Preox Device What is the Mapleson B? The Mapleson circuits were […]

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http://emcrit.org/wee/what-the-heck-is-a-mapleson-b-circuitu-probably-shouldnt-care/feed/ 15 There is a really smart anesthesiologist out there called Nicholas Chrimes. He along with his mate Peter Fritz invented the Vortex Approach to Airway Management. He also runs a blog called Clinical CrEd. - There is a really smart anesthesiologist out there called Nicholas Chrimes. He along with his mate Peter Fritz invented the Vortex Approach to Airway Management. He also runs a blog called Clinical CrEd. He did a post advocating the Mapleson B Circuit as the Ultimate Preox Device What is the Mapleson B? The Mapleson circuits were used for anesthetics in the good old days. At least in the US, we have move to bigger, and arguably better designs for our operative patients. Many would have thought this device would have been consigned to the trash heap, but seemingly not. My Recommended Approaches I recommend two approaches to preox: standard and shunt physiology strategies. I outlines these strategies in the paper Rich Levitan and I wrote. Standard: NRB @ >=15 lpm and NC @ 10-15 lpm for 3 minutes Shunt Physio: Choose 1 BVM with PEEP Valve & NC @ 10-15 lpm NIPPV Ventilator with NIPPV Mask or BVM Mask & NC @ 10-15 lpm Nick makes a number of arguments as to the superiority of the Mapleson circuit over these standard techniques. His points are excellent, but I disagree with pretty much all of them--I think it becomes a question of perspective. Automatic Checking Yes, using the same device for reox and preox makes sure the reox device is there and hooked up, but this for me is an inadequate argument to dispense with NRB/NC set-up. Multiple BVM Masks We don't have these readily available in any ED or ICU I've worked in. We have neonate, peds, and adult. Our masks also are not inflatable. PEEP PEEP is good, Mapleson may or may not be a good way to provide this for the reasons I've mentioned in the wee, but a BVM with a PEEP valve or a vent are at least as good. ApOx Mapleson may provide this better than BVM, but not as well as a NC, which should be on during any intubation. ETCO2 No advantage of Mapleson Low resistance Maybe this matters, as soon as you put on the PEEP, I can't imagine this difference persisting Room Air Entrainment Release your seal for even one breath and you have blown denitrogenation. Always, always use a strapped system if possible=NRB/NC, NIV mask, or BVM mask with OR straps. Troubleshooting Leaks This is the real area in which Nick and I differ. Nick makes the point that a good seal in preox guarantees a good seal in reox--this may be true, but it is unimportant. What I care about is does a bad, one-handed seal in preox mean I won't be able to reox with the BVM--this is entirely untrue. If I did to an awake patient what I will do to them when asleep and desaturating, they would, quite rightfully, punch me in the face. Anesthesiologists should use Mapleson B/C; ED/ICU should only use BVM +/- PEEP Valve with two hands and oral airway and a rocking triple maneuver (that no pt should experience if they are conscious) otherwise they should be NIV mask with straps or (BVM mask with straps). This is the same reason I tell my residents to just train with Macintosh blades. Primary and secondary leaks are the main thrust of Nick's love for the old-timey circuits. But all of us have appreciated this easily by squeezing the bag-valve-mask: Easy-squeezy or Hard Squeezy ETCO2 with a monitor you can see Is he holding or squeezing? I can feel compliance with a BVM if I squeezed it, but I don't unless the pt needs it during reox. But are they squeezing the Mapleson? If they are, they may be doing damage. This study (Anesthesiology 2014;120:326) talks about the myths of Gentle Facemask Ventilation: >15 cmH20 may be entraining gas into the stomach via the LES (in some patients, even 10 cmH20 may be a problem) UES will withstand at least 20 cmH20 until NMB at which point again 15 seems to be the number (The latter is why we don't bag during apnea unless we have to) Two hands ALWAYS on the mask Recently, I spent 2 weeks intubating 10-15 patients per day. One hand mask skills got better and better--all for naught. Train how you want to Fight Hands free Scott D. Weingart, MD clean 19:11
Podcast 119 – Rich Levitan on the Surgical Airway http://emcrit.org/podcasts/levitan-surgical-airway/ http://emcrit.org/podcasts/levitan-surgical-airway/#comments Mon, 10 Mar 2014 16:50:49 +0000 http://emcrit.org/?p=7174 Rich Levitan on Surgical Airway from EMCrit/ISMMS 2014 Conference

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http://emcrit.org/podcasts/levitan-surgical-airway/feed/ 22 EMCrit Conference,featured,Rich Levitan Rich Levitan on Surgical Airway from EMCrit/ISMMS 2014 Conference Rich Levitan on Surgical Airway from EMCrit/ISMMS 2014 Conference Scott D. Weingart, MD clean 26:45 yes
2014 Cabo CME Retreat http://emcrit.org/misc/2014-cabo-cme-retreat/ http://emcrit.org/misc/2014-cabo-cme-retreat/#respond Sun, 09 Mar 2014 15:14:25 +0000 http://emcrit.org/?p=7254 Join Rich Levitan, Mike Mallin, Matt Dawson, Rob Orman, Andy Sloas, and me for a 5-star, all-inclusive vacation in beautiful Cabo San Lucas and earn your CME credits in style. You’ll meet other leading medical professionals, enjoy luxury resort treatment, and learn about the latest advancements in emergency medicine at this exclusive medical retreat. The […]

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Podcast 118 – EMCrit Book Club – On Combat by Dave Grossman http://emcrit.org/podcasts/emcrit-book-club-on-combat-by-grossman/ http://emcrit.org/podcasts/emcrit-book-club-on-combat-by-grossman/#comments Sun, 23 Feb 2014 15:00:28 +0000 http://emcrit.org/?p=6686 Cliff Reid joins me for the 1st EMCrit book club on the book, On Combat by Dave Grossman

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http://emcrit.org/podcasts/emcrit-book-club-on-combat-by-grossman/feed/ 63 Book Club,Cliff Reid,featured,Mind of the Resuscitationist Cliff Reid joins me for the 1st EMCrit book club on the book, On Combat by Dave Grossman Cliff Reid joins me for the 1st EMCrit book club on the book, On Combat by Dave Grossman Scott D. Weingart, MD clean 34:42
Practical Evidence 014 – ACEP Procedural Sedation Update for 2013 http://emcrit.org/practicalevidence/acep-procedural-sedation-update-2013/ http://emcrit.org/practicalevidence/acep-procedural-sedation-update-2013/#comments Tue, 18 Feb 2014 22:26:30 +0000 http://emcrit.org/?p=6812 This one is really good!

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http://emcrit.org/practicalevidence/acep-procedural-sedation-update-2013/feed/ 11 This one is really good! This one is really good! Scott D. Weingart, MD clean 8:42
Podcast 117 – Everyday Emergency Kits with Keith Conover http://emcrit.org/podcasts/everyday-emergency-kits-keith-conover/ http://emcrit.org/podcasts/everyday-emergency-kits-keith-conover/#comments Mon, 10 Feb 2014 16:09:36 +0000 http://emcrit.org/?p=5153 If you are an EM:RAP listener, you have probably heard Mel Herbert's story of 2 cars crashing right outside of his house. Mel realized he did not stock a medical kit in his house with the necessary crucial supplies for an emergency scene. I realized I don't either (there is one in my car). So, I reached out to the master of preparedness, Dr. Keith Conover.

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http://emcrit.org/podcasts/everyday-emergency-kits-keith-conover/feed/ 63 featured,Keith Conover If you are an EM:RAP listener, you have probably heard Mel Herbert's story of 2 cars crashing right outside of his house. Mel realized he did not stock a medical kit in his house with the necessary crucial supplies for an emergency scene. If you are an EM:RAP listener, you have probably heard Mel Herbert's story of 2 cars crashing right outside of his house. Mel realized he did not stock a medical kit in his house with the necessary crucial supplies for an emergency scene. I realized I don't either (there is one in my car). So, I reached out to the master of preparedness, Dr. Keith Conover. Scott D. Weingart, MD clean 30:42