Week in Review: 10/18/20

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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

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

Intubating Oral Airways by Terren Trott

  • Intubating oral airways facilitate fiberoptic intubations by creating a channel to the cords
  • Different brands have different qualities with pros and cons

Prehospital TXA for TBI: Does it Live up to its Hype? by Mohamed Hagahmed

  • This trial showed that giving TXA within two hours of injury to patients with moderate to severe TBI in the out-of-hospital setting did not result in significant neurologic benefit at 6-month follow-up. In my practice, I would continue giving TXA to patients who present with head injury and hemorrhagic shock.

VV-ECMO 101: Going “On Pump” for Acute Pulmonary Failure by Fraser Mackay

  • VV-ECMO is a branch of ECLS that provides supplementary gas exchange for reversible pulmonary disease.
  • VV-ECMO is not for the chronically ill or for those with multi-organ failure. It’s best used early in otherwise healthy patients with devastating single-organ failure.
  • With judicious patient selection and multidisciplinary support, it represents an important salvage modality for those suffering from pulmonary failure.

Rad Review Episode 7: Code Blue MRI by Rupal Jain

  • Pearl #1: The Magnet is ALWAYS ON!
  • Pearl #2: Never attempt to run a code in Zone 4, or the magnet room. The patient will be moved to a predetermined magnetically-safe area, or Zone
  • Pearl #3: MRI Emergency Quench (turning off the magnet) is super rare and is only done in true emergency situations such as if a subject is pinned within or against the magnet or if there is a fire within the gantry that cannot be extinguished.

The Vitals: Priorities in Cardiac Arrest Part 2 by Shyam Murali

After high-quality chest compressions and early defibrillation have been addressed, the next priorities in cardiac arrest are:

  1. Obtain a history
  2. Establish vascular access
  3. Determine which meds need to be given and administer them
  4. Begin basic airway maneuvers and consider whether you need an advanced airway
  5. Treat the reversible causes of cardiac arrest

Management of Organ Donors After Brain Death (Part 1) by Nishika Patel

  • There is no universal set of guidelines on how to manage organ donors after brain death.
  • Donors often require medications such as those listed above to optimize their organs for transplant.
  • Contact your local organ procurement team for assistance on medication selection and dosing.

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