So I figured I would knock out some of the questions we were sent now that we sit at the end of the year.
Questions Addressed
Dealing with ICP Increases in a Patient with Hyponatremia?
Can you Trust an Aline with a Very Low BP but a Conscious Patient?
Should We do 30:2 Breath Pauses with BVM during CPR?
Ketamine to Blunt Post-RSI Awareness?
Can you use Propofol for Post-Intubation Sedation with Poor Heart Function?
- Scherer, Clemens, Jan Kleeberger, Antonia Kellnar, Leonhard Binzenhöfer, Enzo Lüsebrink, Thomas J. Stocker, Stefan A. Berghoff, et al. “Propofol versus Midazolam Sedation in Patients with Cardiogenic Shock – an Observational Propensity-Matched Study.” Journal of Critical Care 71 (October 1, 2022): 154051. https://doi.org/10.1016/j.jcrc.2022.154051.
Dealing with Ketamine Laryngospasm
Additional New Information
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An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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The concern I have with BMV during chest compressions, is gastric insufflation followed by vomiting.
Scott, can you give the reference from this episode regarding the use of propofol being safe in patients with heart failure?
Thanks
Yosef Levenbrown
added above
Reason to use mannitol – 1) if the patient is volume overloaded 2) severe icp crisis where you want to give hyperosmolar therapy every 3 hours (3% and mannitol every 6hrs staggered so patient gets something every 3hrs) at least this is how I use mannitol
What is your explanation that propofol did not show its cardio- and vasodepressive effects in this study?
I don’t think propofol has any negative inotropy at sedation doses, I think it only kicks in at general anesthetic doses
Thabks for another great podcast and thanks for all of the education over the years Scott. For what its worth, the AHA ACLS provider manual has specified that “high performance teams” can perform asynchronous chest compressions and ventilation using bvm without advanced airway in order to improve chest compression fraction. This has been accepted since the release of 2015 guidelines but can be found in the manual for 2020 on page 92 and page 122 specifically. I’m not sure of their reference citations but it makes sense since older animal studies support compressions only with passive oxygenation vs bvm, it… Read more »
at what point during topical awake do you become concerned that blunting all the protective reflexes are blunted increasing concern of aspiration?