EMCrit

Prior to extubation, the cuff leak is usually checked.  This consists of deflating the cuff of the endotracheal tube to verify that gas is able to move around the tube.  Absence of a cuff leak suggests the presence of airway edema, increasing the risks of post-extubation stridor and reintubation.  However, the test isn't that great.  Absence of cuff leak can also occur due to … [Read more...]

In 2014 I wrote a post suggesting an aggressive, streamlined approach to status epilepticus involving early intubation.  The fundamentals of that post remain valid.  However, much has changed over the last few years.  This post aims to refresh and extend the prior post.  It will also serve as a reference to explain my algorithm for status epilepticus in the upcoming … [Read more...]

Background:  Devil in the details Airway management is a detail-oriented sport.  Minor nuances of patient positioning can be essential.  Or gentle laryngeal manipulation.  Apneic oxygenation can improve first-pass success.  Placing the pulse oximeter on the same arm as the blood pressure cuff can cause real headache.  Failure to recognize and remove dentures is an enormous … [Read more...]

Follow-up data from the PEITHO trial shows that thrombolytics don't affect long-term morbidity.  This simplifies management substantially. PEITHO trial & long-term follow up The PEITHO trial was a multi-center RCT investigating the effect of thrombolysis in submassive PE.  Tenecteplase caused an increase in intracranial hemorrhage and a reduction in hemodynamic collapse.  … [Read more...]

Sepsis resuscitation generally focuses on hemodynamics.  Rivers of ink have been spilled writing about oxygen delivery and fluid responsiveness.  This is clearly important, but it's possible that our focus on easily observable phenomena has led us to ignore something of equal importance: metabolic resuscitation.  We can deliver all the oxygen we want to the tissues, but if the … [Read more...]