Awake Intubation from SMACC 2015
Search Results for: procedural sedation
Extubating COVID Patients with thoughts from Guest EMCritter, Sahar Ahmad
If you put it in, you need to be able to take it out.
EMCrit 19 – Non-Invasive Positive Pressure Ventilation (NIPPV)
Intubation is a sexy procedure, there is no doubt about it.
NIV does not have the glamour; it’s not nearly as cinematic. But for the patient, to spend 30 minutes on a NIV mask is preferable to a couple of days on the ventilator. In this episode, I discuss some of the basic ideas and methods of NIV.
PulmCrit- My favorite 20 abstracts from SCCM
The Society of Critical Care Medicine published over 1,800 abstracts to go along with their latest conference. I sifted through them to come up with my favorite 20. Kudos to all the authors on creating diverse and thoughtful work – the future of critical care is indeed bright! The abstracts are divided into six groups: […]
PulmCrit- Fentanyl infusions for sedation: The opioid pendulum swings astray?
I’ve been using fentanyl infusions as the backbone of my sedative strategy, in keeping with the 2013 SCCM guidelines. This generally works well for patients who can be extubated quickly. However, for patients who remain on the ventilator for longer periods of time, it often leads to problems involving tolerance and withdrawal.
EM Nerd-The Case of the Inert Remedy
In 1959 Cobb et al published a trial of 17 patients investigating the efficacy of internal mammary artery ligation for the treatment of symptomatic angina. The authors randomized 17 patients “seriously limited by angina” to either bilateral internal mammary artery ligation or a blinded sham procedure (1). At 6-months follow up the authors reported the […]
PulmCrit- Rocketamine vs. keturonium for rapid sequence intubation
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 […]
EMCrit 313 – Tube Thoracostomy (Chest Tubes) Part 2
Chest Tube Insertion (Part 2 of a 2 part series)
Atrial Fibrillation (AF) & Flutter complicating critical illness
CONTENTS Introduction Diagnosis of AF Investigation of the cause of AF Management – Overall approach Emergent cardioversion Is immediate cardioversion indicated? How to perform DC cardioversion (1) Universal AF stabilization package (2) Rate vs. rhythm control decision Rhythm control in critical illness Rate control (3) Anticoagulation Atrial flutter Pharmacopeia for AF in the ICU: Amiodarone […]
PulmCrit- Alpha-2 agonists: clonidine, guanfacine, lofexidine, and KetaDex
Dexmedetomidine is an intravenous alpha-2 agonist used as a sedative infusion. It has some uniquely useful properties, particularly that it doesn’t suppress respiration (allowing it to be safely used in non-intubated patients). The main drawbacks of dexmedetomidine are logistic: it is expensive and can be administered only as an IV infusion within an ED or ICU. Oral clonidine offers some similar benefits compared to dexmedetomidine, without these logistic constraints.
EMCrit 310 – Transvenous Pacemakers
As you might imagine on an EMCrit podcast, there are a ton of logistical details on placing and managing transvenous pacemakers.
Guide to supportive care in critical illness
CONTENTS Rapid Reference 🚀 The understated importance of high-quality supportive care Medications to avoid in ICU Prophylaxis DVT prophylaxis GI prophylaxis Anemia & transfusion targets Glycemic control Nutrition for the intubated patient Pain, agitation, and delirium Analgesia & pain management Sedation of the intubated patient Delirium prevention Volume status & diuresis Electrolyte management Troponin elevation […]
EMCrit 330 – Rural Resus Explosion
more on rural resus
Hemodynamic access for the crashing patient: The dirty double
0 0 Introduction with a case 0 A 75-year-old man presents in transfer to the ICU for management of bradycardia and hyperkalemia. His history is notable for hypertension with chronic use of an ACE-inhibitor. He developed gastroenteritis due to endemic Norovirus some days prior. Today he presented to the outside hospital with hypotension and […]
PulmCrit- Reengineering the analgesic ladder for critically ill patients
We all want to alleviate pain and suffering. Most critically ill patients are treated with opioids for this reason. Unfortunately, opioids have numerous side-effects including delirium, constipation, vomiting, and delayed extubation. Opioid infusions may eventually lead to withdrawal, causing pain, nausea, and depression. This post explores the optimal use of systemic medications to control pain while minimizing complications.
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