CONTENTS Rapid Reference 🚀 Physiologic effects Specific agents Nitric Oxide (NO) Nitroglycerine Epoprostenol Milrinone Oxygen Contraindications & adverse effects Indications Overall concept – temporary bridge ARDS Pulmonary embolism Decompensated chronic pulmonary hypertension Right ventricular myocardial infarction Podcast Questions & discussion Pitfalls Inhaled pulmonary vasodilators yield three physiological advantages: #1) reduced pulmonary vascular resistance Pulmonary vasodilation […]
Search Results for: aprv
Brain Death
CONTENTS Brain death basics Clinical presentation of brain death Clinical context Clinical findings in brain death Spinal reflexes Diagnosis of brain death (1) Initial suspicion (2) Evaluate for confounders Excluding drug intoxication (3) Dedicated neurologic examination (4) Apnea test (5) Confirmatory test PRN If brain death is confirmed: Immediate next steps Supportive care prior to […]
Severe influenza
CONTENTS Rapid Reference 🚀 Clinical presentation Radiology Bacterial coinfection Diagnostic panel Treatment Resuscitation Antibiotics Anti-viral therapy Respiratory support Adjunctive therapy Virus-associated hemophagocytic syndrome (VAHS) Approach to treatment failure Extrapulmonary complications Virology of influenza Podcast Questions & Discussions Pitfalls severe influenza checklist ✅ diagnostic tests (more) Nares PCR for MRSA. Blood cultures. Sputum gram stain & […]
Management of COVID-19 patients admitted to stepdown or ICU
CONTENTS Rapid Reference 🚀 Initial tests to guide management Chest CT findings Organ support Cardiovascular Respiratory Noninvasive respiratory support Invasive mechanical ventilation Infectious disease – antibiotics Renal Hematology Neurology Immunomodulation Steroid Tocilizumab Baricitinib Tofacitinib Things that don’t work Remdesivir Convalescent plasma Questions & Discussion References checklist for COVID admission to ICU/stepdown ✅ Review medication list […]
EMCrit 60 – On Human Bondage and the Art of the Chemical Takedown (Violent Patient Sedation)
In this episode, I discuss the takedown and restraint of the violent, agitated delirium patient. This is a team sport and requires a coordinated approach for the safety of the patient and staff.
Beautiful Words
@susie_dent · Apr 21 From @susie_dent The words that soothe me: susurrus: the whispering of leaves. spindrift: the tang of the sea whipped up by the wind. halcyon: a time that was once idyllic and happy. ethereal, marmalade, kismet, dwindle, gloaming, gossamer, saudade, hiraeth petrichor Komorebi: light filtered through leaves. Lambent – Not only the […]
Esophageal vs. Other Temperature Monitoring Locations
Weis J, Covaciu L, Rubertsson S, Allers M, Lunderquist A, Ahlström H. Noninvasive monitoring of brain temperature during mild hypothermia. Magn Reson Imaging. 2009 Mar 10. [Epub ahead of print] Lemire B, Gagnon D, Jay O, Dorman L, DuCharme MB, Kenny GP. Influence of adiposity on cooling efficiency in hyperthermic individuals. Eur J Appl Physiol. […]
EMCrit 63 – A Pain in the Neck – C-Spine Imaging and Clearance
In this episode, I discuss the diagnosis of c-spine injuries. I argue that we should not send patients to imaging unless we have used the NEXUS rule and then added the Canadian C-spine Rule to the sequence. If we are imaging, it should be with a 3-view reconstructed CT scan. And even after that is done, you still need a clearance exam before removing the collar.
EMCrit 86 – IVC Ultrasound for Fluid Tolerance in Spontaneously Breathing Patients
Can the Inferior Vena Cava Ultrasound guide our fluid administration in the ED? Of course it can!
Peripheral 3% and 23.4% Hypertonic Saline is Safe
Peripheral 3-7.5% Hypertonic Saline There are still pharmacies that believe that 3% Hypertonic Saline can only be given through a central line. The evidence would go against this assertion: Brenkert TE et al. Intravenous Hypertonic Saline Use in the Pediatric Emergency Department (Pediatr Emer Care 2013;29: 71Y73) Bulger, Eileen M, Susanne May, Karen J Brasel, […]
Post-cardiac arrest management
CONTENTS Rapid Reference 🚀 Cause & investigation Subsequent management: Targeted temperature management (TTM) Shivering management Cardiovascular interventions Pulmonary optimization ID: Aspiration pneumonia & antibiotics Endocrine: steroid Neurologic issues Podcast Questions & discussion Pitfalls investigations ✅ labs Fingerstick glucose. Basic labs (electrolytes including Ca/Mg/Phos, CBC, INR, PTT). Lactate. Troponin. Blood cultures if concern for sepsis. Pregnancy […]
Situation Awareness in Resuscitation by Mike Lauria
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EMCrit 138 – Vasopressor Basics
There is a ton to speak about regarding vasopressors, but before we get to the edge cases, we need to set-up a foundation.
Abdominal compartment syndrome
CONTENTS Rapid Reference 🚀 Causes Epidemiology Physiological relationships between various compartments Physiology & manifestations Diagnosis Treatment Hemodynamics Decompress the abdomen Decompress the thorax Sedation & paralysis Podcast Questions & discussion Pitfalls treatment of abdominal compartment syndrome ✅ hemodynamics (more) Target MAP > (60 mm + abdominal compartment pressure). Don’t give additional fluid. Consider diuresis/dialysis, if […]
Resus.ME: Learning To Speak Resuscitese
Avoid the whimperatives
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