Week in Review: 10/11/20

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Shyam Murali
Shyam Murali
Fellow in Trauma and Surgical Critical Care - University of Pennsylvania, Senior Editor - CriticalCareNow.com, Writer - RebelEM.com, Saxophonist, EDM remixer, husband, puppy father, and new human father

ResusX:Rewired took place this week and was a BLAST! Even in a virtual format there was an incredible amount of education in a fun and interactive format. Stay tuned for future recaps from the conference!

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

Equation of Motion Part 2: Application by Aman Thind

  • Key formulas: Compliance of the respiratory system (CRS) = tidal volume/(Pplat – total PEEP)
  • Inspiratory resistance (RI) = (PIP – Pplat)/(constant) flow
  • The easiest way to assess both resistance and compliance simultaneously is VC-constant flow.
  • A constant flow pattern (square waveform) is a pre-requisite for the measurement of resistance.
  • A brief post-inspiratory pause (<0.5 seconds) provides the most clinically relevant estimate of plateau pressure.
  • Knowledge of the resistive and elastic loads has important diagnostic and therapeutic implications.

ResusX19: Pearls from Day 3 by Shyam Murali

  • Hear are your learning pearls from the day 3 lectures of ResusX19!

Post Resuscitation Debriefings by Jeff Pepin

  • Debriefings are a simple tool that can dramatically improve team dynamics and performance to improve patient safety. This should be a brief session done as soon after the event as possible and held in an environment and tone that encourages debriefing participation by all and highlights great performance and improvement.

Finding an LVAD MAP: What the Books Don’t Tell You by Andrew Phillips

  • The cuff pressure at which doppler is first detected as the cuff pressure is reduced is considered the MAP for LVAD patients because they often do not have a detectable pulse pressure on noninvasive blood pressure measurements.
  • It is important to find the location of the artery with doppler first, THEN inflate the cuff to the point of no longer observing doppler signal, THEN deflate the cuff and mark the pressure.

What in the World is TAPSE? by Segun Olusanya

  • Pearl #1: TAPSE stands for Tricuspid annular plane systolic excursion, and it’s a measure that correlates well with RV ejection fraction
  • Pearl #2: TAPSE is measured in an apical 4 chamber view, ideally focused on the right ventricle, using M Mode to accurately measure the vertical movement of the lateral tricuspid annulus.
  • Pearl #3: TAPSE is limited as it is angle-dependent and only focuses on one movement (vertical) of the RV’s complex 3-dimensional actions. You can have normal TAPSE with a dysfunctional RV!

The Vitals: Causes of ST Elevation by Shyam Murali

Consider dividing up the causes of ST elevation into the following categories:

  • The Usual Suspects
  • Lefties and Righties
  • H’s
  • Names
  • Disasters

Cangrelor Clinical Pearls by Lauren Igneri

  • Cangrelor can be used as an IV substitute for P2Y12 inhibitors
  • Check out the post for the indications and dosing strategies

I Got Some Beef With the P/F Ratio! by Sharad Patel

  • S/F was a stronger predictor of mortality than P/F based upon our data’s feature importance evaluation.  S/F should be considered as the primary method for hypoxia assessment in the ICU.


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