Mind of the Resuscitationist - EMCrit Blog - Emergency Department Critical Care

Mind of the Resuscitationist – Chicken Bombs and Muppet Factors

Cliff Reid adds to the MotR lexicon with Chicken Bombs and Muppet Factors

Podcast 87 – Mind of the Resuscitationist: Stop Points

In this Mind of the Resuscitationist Episode, I discuss stop points: one for when you are using multiple vasopressors and especially about a cognitive stop point whenever things are going south.

2nd Vasopressor Stop Point

Rapid Ultrasound for Shock and Hypotension (RUSH) Exam

The RUSH Exam will allow rapid diagnosis of the cause of non-trauma hypotension

Abdominal Compartment Syndrome

See this crashing patient chapter for more on Abdominal Compartment Syndrome

Cognitive Stop Points for the Resuscitationist

Use this method whenever the situation doesn’t add up or is going bad:

Announce you have no idea what the f**k is going on
Eliminate ALL assumptions
Troubleshoot like an engineer

Shoutouts

Ken Grauer sent me a copy of his new book, ACLS 2013 Pocket Brain Book. Check it out and check out his blog site as well.

My friend Clay Smith of the KeepingUp Podcast has just put out a new, FREE!, IOS app called Upshot that combines his literature reviews and podcasts into one beautiful package.

Did you Like this Episode? Then tweet the hell out of it:

Podcast 87 is a Mind of the Resuscitationist Episode on Stop Points and Engineers emcrit.org/podcasts/stop-…
— Scott Weingart (@emcrit) November 26, 2012

Now on to the Podcast…

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Podcast 82 – Mind of the Resuscitationist with Cliff Reid

Today, I put on my head-shrinker cap (it is a fez) and get Cliff Reid on the coach. You know Cliff from his previous podcasts:

and his insanely good blog:

Cliff discusses a case of an out-of-hospital cardiac arrest that he has been ruminating about for the past few days. Here are the teaching points that came out of the case:

Can we lyse intra-arrest?

We will discuss this question in a future show. For now, I would say if you strongly suspect PE or MI and you have exhausted other options, intra-arrest lysis is still an option.

The pulse you feel in the groin may be the vein

During the discussion Cliff mentions that he demonstrated to his whole team that the pulse they felt in the groin was the femoral vein. Use ultrasound for all intra-arrest groin catheter placements.

Securing lines during a code

I use 2″ tape. Cliff mentions during the discussion and on his blog, using tissue glue instead.

Continue CPR if there is an a-line pulse, but the pressure is low

Otherwise these patients will just re-arrest. Here is an article on thoracic pump vs. cardiac pump.

Percussion Pacing

Never heard of this? Read this manuscript on percussion pacing.

The Ethics of Different Capabilities at Geographically Close Hospitals

I want to hear what you folks think about this. Should all sick patients be taken to the closest hospital that has the most potential life-saving capabilities? Is there ny reason to bring really sick patients to tiny hospitals if the trip to a more advanced hospital only adds a few minutes? Let me know in the comments what you think.

The Mind of a Resuscitationist – A Resuscitationist Agonizes

This is why I really wanted to post this podcast. I run a series called the Mind of a Resuscitationist. For instance, the episode on

Logistics not Strategy

Today’s episode hits another key point to a resuscitationist’s mind: we agonize. We dissect every case that did not go perfectly to figure out if there was ANYTHING that could have gone better, been done smoother. This obsession leads to ulcers and interrupted sleep patterns AND better outcomes in the future.