Week in Review: 2/07/21

by Melina Alexander February 7, 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:

Ketamine is still a strong choice for the induction of a hemodynamically fragile patient.
Ketamine can increase blood pressure by inhibiting the catecholamine reuptake channels.
If the catecholamine supplies are exhausted or the receptors are desensitized this inhibition may not matter.
In this hemodynamically fragile patient we should always anticipate post intubation hypotension regardless of what induction agent we are use.
Preparation for post intubation hypotension should include obtaining good IV access, resuscitating before intubating, and setting the BP cuff to cycle frequently.

In this study looking prospectively at team leadership performance and patient outcomes (saying this louder for the people in the back) – there is no support for previously reported gender-based differences in team leadership.
Although our focus should be on ensuring that all our trainees (whoever they are) are educated in a manner where they are empowered to be effective and safe team members and leaders, we must acknowledge that gender issues in medicine continue to raise their ugly head…the fact that this continues to appear in the literature is a case-in-point.
Our entire team implores you to tackle this issue head-on and call it out when you see it.

Cardiac transplant leads to interruption of the nerve supply to the heart
These patients cannot feel angina
They will not have an appropriate heart rate response to hypotension or hypovolemia
Cardiac medications will have atypical effects, with vagolytics being ineffective and adenosine having exaggerated effects.

A well-described drug-drug interaction exists between carbapenem antibiotics and valproic acid and therefore the combination should be avoided outside of a toxicological circumstance
Meropenem and ertapenem have been documented to reduce serum VPA levels up to 90% and therefore may be a unique method to treat valproic acid overdose
The benefits of a short course of antibiotics may outweigh the risks related to antimicrobial stewardship
Carbapenems should not replace standard therapy but may be an excellent adjunct
No specific Meropenem or Ertapenem dosing strategy has been recommended

The bottom line when trying to maximize engagement in virtual learning is to limit the time your learners are staring at a static slide on a computer screen and leverage opportunities for group participation.

- HFNC can help support increase respiratory demand thus decreasing retractions
- HFNC hydrates mucus helping to facilitate mucociliary clearance allowing for easier suctioning
- Be sure to set appropriate settings and use the appropriate cannula

The Rule of 2’s by Shyam Murali

Internal jugular vein catheters have increased risks of infection and DVTs; consider the subclavian vein for central venous catheters instead!
Use ultrasound for placement of the subclavian vein catheters
Your target may actually be the axillary vein
Use the long axis view on the ultrasound to reduce the chance of going through the back wall of the vein
Check out the video for more tips and tricks!

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