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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:
ETCO2 & Dead-Space by Steve Haywood
- Dead space is gas in the pulmonary system that does not participate in gas exchange.
- We have normal anatomic dead space made up of the trachea and bronchial tree.
- Patients also have physiologic dead space composed of alveoli that are not participating in gas exchange.
- When the fraction of dead space exceeds 0.3, we must have a concern that our patient’s physiologic dead space is increasing.
Can we Just Stay and Play a While? by Zaf Qasim
- Transporting a patient without achieving ROSC means that there will be interruptions in chest compressions
- This recent study showed that patients who received on-scene resuscitation until ROSC had improved survival to hospital discharge and survival with favorable neurological outcome
Off-Label Drug use in Pediatrics by Samantha Dallefeld
- There are some very important considerations when giving medications to pediatric ICU patients for off-label uses
- Remember to consider the differences in metabolic capacity, renal function, distribution, skin development, and GI function
Let’s Talk Tamponade (Physiology) by Gurkeerat Singh
- Always use EKG leads to identify systole and diastole.
- Tamponade is a clinical diagnosis that depends on hemodynamics at a particular point in time.
- Severe pulmonary hypertension will protect from RV and RA collapse leading to atypical sings for tamponade. Drainage can lead to death.
- Significant pleural effusions can lead to tamponade which can reverse with effusion drainage.
The Vitals: When to Pull the Tube by Sunil Ramaswamy
- Remember to use your eyes, ears, and communications skills when deciding if a patient is ready for extubation
- The Rapid Shallow Breathing Index (RSBI) can help predict if extubation is likely to fail
The Acutely Agitated Adult ED Patient by Rachel Rafeq
- There are many options for treating the acutely agitated adult patient
- Use the infographic in this post to learn about how to manage them
Central Line Tips & Tricks: Part 3 by Harman Gill and Shyam Murali
- Get the kit and ergonomics essentials from the previous videos (Part 1 and Part 2)!
- One hand technique vs having a helping hand to drape the US probe; this is a big area of procedural contamination.
- There are different types of introducer needles – check your kit or watch the video
- Sharp angle for introducer needle entry and then drop the angle when you advance wire
- Confirm wire in two planes with US
- Avoid skin tags
- Once you feel the ‘give’ with the dilator, make sure the wire advances and retracts with no resistance
- Angle of dilation should mimic the angle of introducer needle entry…not sure what this means…watch the video!
