Week in Review: 11/8/20

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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:

The Battle for Cor Pulmonale by Matt Siuba and Brendan Riordan

  • ACP is best identified with POCUS, whether TTE or TEE. Invasive hemodynamic monitoring may play a role in select circumstances.
  • Targets to monitor response to therapy are not well defined
  • ACP prevention shares common ground with best practices for ARDS including lung-protective ventilation and prone position ventilation. This can be considered “RV-protective ventilation”.
  • Reduction of preload (via diuresis or ultrafiltration) should be considered
  • Afterload reduction is more challenging. Treat acid/base and gas exchange abnormalities as able. Inhaled pulmonary vasodilators are a physiologically appealing therapy for ACP but without strong evidence to support it.
  • Inotropic therapy may be attempted, but is a bridge at best.
  • Consider consultation with an experienced ARDS and extracorporeal life support center if the above was unsuccessful.

2020 AHA CPR Guidelines: What is New? by Mohamed Hagahmed

  • The AHA’s 2020 CPR guidelines provide a comprehensive guide to resuscitation.
  • In addition to highlighting some of the issues related to patients with opioid overdose, they also address the existing racial and gender disparities in CPR education.

High Frequency Oscillatory Ventilation in Pediatrics by Samantha Dallefeld

  • In the right patient, HFOV is a good mode of ventilation to support oxygenation and decrease ventilator induced lung injury. Hopefully, in the coming years we will have more information to support (or not!) the use of this device in critically ill patients with respiratory failure.

How to Get “Good” Bat Views by Segun Olusanya

  • The “Bat” view describes the view obtained of the pleural line, bounded on either side by two ribs. It is the “home screen” of lung ultrasound in the anterior zones
  • An optimal view of the pleural line allows for optimal visualization of all of the described artifacts- lung sliding, B lines, pleural abnormalities, and lung points
  • Because ribs are angulated, getting perfect “bat” views requires probe angulation to align yourself with the rib space

The Vitals: Surviving Sepsis Campaign 2018 Update by Shyam Murali

  • The 2018 Surviving Sepsis Guidelines Update converts the 3- and 6-hour bundles into an “Hour-1 Bundle” for sepsis patients

Management of Organ Donors After Brain Death (Part II) 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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