Week in Review: 2/14/21

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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:

Airway Foreign Body by Terren Trott

  • Presentation of an inhaled foreign body can range from a mild cough to cardiac arrest.
  • Common radiographic findings include persistent areas of atelectasis or pneumonia
  • Removal is usually successful with rigid or flexible bronchoscopy.

Push Dose Pressors: Know them before you need them by Mohamed Hagahmed

  • Push dose pressors may be considered for rapid correction of transient hypotension as a bridge to definitive treatment.
  • Know how to prepare a push dose pressor, or use our criticalcarenow.com resource as a reference.
  • Ensure safety and take caution while administering push dose pressors.
  • When in doubt, consultation with a pharmacist may reduce dosing errors.

Thyroid Storm by Brian Freeman 

  • TS is a rare, though life-threatening illness, and its etiology and triggers may be difficult to diagnose.
  • Clinical manifestations of TS may present with a variety of signs and symptoms including hyperthermia, altered mental state, cardiac arrhythmia, hemodynamic instability and GI dysfunction.
  • Prompt identification and initiation of treatment is necessary to avoid rapid decompensation and death.
  • Treatment should consist of a beta-blocker, thionamide, iodine solution, steroids and bile acid sequestrants.
  • If unsuccessful, plasmapheresis or surgery may be attempted.

Try This to Maximize Feedback Retention by George Willis

  • Search for an emotional response to your feedback
  • Be specific
  • Be timely
  • Make a time and place for feedback
  • Give more frequent feedback
  • Ask for feedback on your teaching

What You Need to Know About Urine Drug Screens by Nishika Patel

  • Obtain a urine sample earlier rather than later if an intoxication/overdose is suspected to minimize the chance of a false-negative result.
  • If obtainable, record a detailed medication history including prescriptions, over-the-counter medications, herbal remedies, or any illicit drugs the patient is taking.
  • If you feel there is an immunoassay UDS with questionable results, ask to have a GC-MS test done if it is available at your institution. If GC-MS is not available, review the patient’s medication list to see if there are any medications that could potentially cross-react with the immunoassay and cause a false-positive result.

Inhaled Nitric Oxide by Linda Melchor

  • iNO relaxes smooth muscles, increasing bronchodilation, and has anti-inflammatory effects
  • iNO has many uses in respiratory care, including PHTN, COVID-19, ARDS, and COPD
  • iNO should be weaned slowly to prevent rebound PHTN

The Vitals: Hypocalcemia by Obiajulu Anozie

  • The incidence of hypocalcemia in critically ill patients is variable depending on underlying disease process and comorbid conditions; however, it is a commonly observed occurrence.  
  • Clinical features of hypocalcemia may include tetany, seizures and cardiovascular abnormalities such as reduced cardiac output and life-threatening arrhythmias 
  • The approach to treatment should place emphasis on overall calcium homeostasis and how it may be impaired in the affected patient

Stop the Central Line From Going North by Haney Mallemat

  • Use the Ambesh maneuver to prevent the central line wire from going into the internal jugular
  • Put gentle pressure in the supraclavicular region above the medial portion of the clavicle
  • You can also use the ultrasound to make sure your wire is in the right location


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