Week in Review: 1/3/20

by Melina Alexander January 3, 2021

Reading Time: 2 minutes

St. Vincent's Emergency Medicine Resident, PGY-1

For some spaced repetition, here’s a review of this week’s content:

Bougie Bonanza by Richard Cunningham

Use of a bougie leads to higher first-pass success compared to ETT+stylet
The bougie allows increased visual as well as tactile confirmation of endotracheal placement
The “tracheal clicks” and “hold-up” signs are highly sensitive and specific markers to confirm successful placement
Successful placement is further confirmed with a second operator holding his or her hand over the tracheal and feeling clicks

When managing patients with GCSE, we need to consider a wide range of possible causes beyond medication nonadherence.
Many of the etiologies are rapidly reversible when correctly identified and treated, which ultimately results in reducing morbidity and mortality.

Think about MIS-C in a patient with prolonged fever, multiorgan system involvement, and a history of or close contact with SARS-CoV-2.
If MIS-C is in your differential, send labs to evaluate for inflammation and consider cardiac work up including an echocardiogram.
The mainstay of treatment for MIS-C is IVIG +/- steroids and aspirin and/or VTE prophylaxis.
MIS-C patients are often treated in consultation with cardiology, hematology, and infectious disease.

High dose insulin is a recommended treatment strategy in the management of calcium channel blocker and beta-blocker overdose
The regimen includes 1 unit/kg bolus followed by a 0.5-10 unit/kg/hr infusion which should be accompanied by 0.5 gram/kg/hr dextrose infusion to prevent hypoglycemia
The patient’s glucose and potassium should be carefully monitored in the first 24 hours after insulin discontinuation

Negative pressure ventilation was widely used before 1960, but it is still used in some departments.
The more natural physiologic nature of negative pressure has promising potential for may disease processes.
Negative Pressure Ventilation is contraindicated in patients with impaired airway protection, uncooperative patients, and unstable patients.

Why are some people able to thrive in chaotic or disordered environments? Most likely because they choose to thrive rather than succumb.
Stoicism teaches that we have a choice in how we respond to external factors. While we cannot control an outside stimulus, we can control our feelings, thoughts, and responses.
Complex systems have been characterized by either their fragility (the ability to easily fail), their robustness (the ability to withstand failure), and resiliency (the ability to recover from failure) in the face of stress or volatility. There is a fourth state: anti-fragility. This is the property of a system to become stronger in situations of shock or chaos.
Antifragility leads to strength when one is able to properly recover after a stress. In order to be antifragile resuscitationists, we must choose this path.
While 2020 might have been the year or resiliency, let’s make 2021 the year of antifragility. Let’s choose to thrive, no matter what we are faced with.

The ultrasound can be used for more than just getting the needle into the vessel!
Use the ultrasound to confirm wire placement, check for pneumothorax, and look for air bubbles in the heart when injecting agitated saline.