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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:
Basics of Dead Space Ventilation by Aman Thind
- Dead space represents the volume of ventilated air that does not participate in gas exchange.
- The causes of true dead space are (a) anatomical dead space and (b) alveolar dead space. Conditions that create a ‘dead space effect’ are (a) high V/Q units in a heterogenous lung, and (b) shunt.
- Physiological dead space = (PaCO2 – PECO2)/PaCO2. It is the global measure of wasted ventilation that incorporates true dead space as well as conditions that create a dead space effect.
- Rapid shallow breathing pattern and respiratory equipment distal to the ventilator wye increase the anatomical dead space fraction.
Save a Tooth Today: Dental Trauma Management by Ashika Jain and Amar Jain
- Emergency management including dental consults should occur if a tooth has completely avulsed, severely pushed in or there is a fracture with visible blood/root
- Just about everything else can wait until the morning
Acute Liver Support Series: Acetaminophen Overdose in the ICU by Fraser Mackay
- APAP overdose in the ICU is a scary thing, but it’s also something most ICUs can handle (or at least temporize). Most of these patients if given early and aggressive therapy can make it to a very acceptable and high quality level of survivorship.
- Reasons to transfer early to a liver center include
- Multi-organ system dysfunction and/or cardiovascular collapse
- Massive Overdose
- Refractory acidosis
- Watch out for the neurologic sequelae of acute liver failure:
- Screen for intracranial hypertension syndromes
- Treat with hyperosmolar therapy when needed
- Mitigate Ammonia levels >150 aggressively, considering CRRT early in their hospital course
- Be Patient and Aggressive. Especially when young, even massive overdoses that look terribly sick can bounce back.
- Reasons to transfer early to a liver center include
Oscillator in the NICU Part 1: The Basics by Cristina Baj
- HFOV is lung-protective ventilation for neonates.
- Watch for wiggle factor. Baby should wiggle from nipple line to umbilicus
- Power and Amplitude are ventilation controls.
- MAP and FIO2 are oxygenation controls.
How do you Manage Shivering During TTM? by Nishika Patel
- Preventing shivering is vital in achieving and maintaining a hypothermic state during TTM.
- Medications that reduce the seizure threshold should be attempted before using paralytics which stop shivering completely, due to the risks associated with paralytic use.
- If seizures occur, they should be treated promptly; however, seizure prophylaxis is not recommended.
The Vitals: Ammonia-Related Encephalopathy by Obiajulu Anozie
- Through our understanding of ammonia generation along with its various pathways of degradation, treatment strategies become more evident with a higher likelihood of success.
Central Line Tips & Tricks: Part 5 by Harman Gill and Shyam Murali
This week’s procedure video talks about three main troubleshooting tips: dilator won’t pass, arrhythmias, arterial puncture/dilation.
- Check out the show notes and video for more info on these troubleshooting pointers!
