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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:
Acute Cor Pulmonale in ARDS: Top 10 Things you Need to Know by Matt Siuba
- RV function is directly influenced by lung function
- Hypoxemia, hypercarbia, and acidemia increase PVR
- In ACP, RV dysfunction is due to acute increase in PVR
- ACP is probably still underrecognized
- ARDS patient turning “septic?”- think about ACP
- Diagnose it! TTE/TEE, invasive monitoring.Â
- Prevent strategies include RV-protective ventilation, decongestion, and consideration rescue therapies early.
Understanding the Enemy: In-Hospital Cardiac Arrest in COVID19 by Jeff Pepin
- COVID patients that were younger with fewer comorbidities and were admitted to larger institutions were more likely to survive their critical illness of COVID19.
- The authors reference that cardiac arrest in critically ill patients with COVID19 appeared to be predominantly related to non-cardiac causes.
- Respiratory failure and prothrombotic events that have been extensively described in patients with covid-19 are probably significant contributors to in-hospital cardiac arrest in this setting.
Simplified Algorithm for ACLS in LVAD Patients by Andrew Phillips
- Establish perfusion, not pulses.
- Shock and do compressions as you would with anyone else in the ACLS algorithm.
- Consider gingerly providing epinephrine in complete arrests, rather than full, 1mg slugs q3-5 min.
The Art of Pediatric Ventilation: Flow Inflating Bag by Tammy Dutch
- Flow inflating bags must have oxygen or compressed air to operate.Â
- The adjustment wheel sets the desired peep.Â
- Maintain the sniffing position without hyperextension of the neck in children.
The COVID Variant by Matthew Tyler
- Yes, the virus mutates…a lot. That’s expected.Â
- Yes, this particular lineage made a big mutant jump compared to prior variants.
- No, we don’t have enough solid information to know how infectious this strain is or if it is any more lethal than prior variants.
- No, it’s unlikely the vaccines will become obsolete this quickly.
- Yes, we need to collect more data to make any meaningful conclusions.
- Yes, everyone still needs to wear masks, practice social distancing, and get the vaccine when available to them.
What is RV Fractional Area Change? by Segun Olusanya
- Fractional area change adds (yet) another tool to assess RV function
- It’s defined as the difference between end-diastolic and end-systolic RV areas, divided by end-diastolic area
- It correlates well with MRI measured RV ejection fraction
- It’s measured in an RV Focused apical 4 chamber view, by tracing end-diastolic and end-systolic areas
- Care should be taken to ensure the accuracy of the tracings
- While it improves the sensitivity of RV assessment by including the free wall, it’s highly user-dependent
