Week in Review: 3/14/21

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Melina Alexander
Melina Alexander
St. Vincent's Emergency Medicine Resident, PGY-1

Read this weekly review for some spaced repetition of the past week’s content.

Practical Plan for a Needle Cric! by Steve Haywood and Caleb Harrell

  • Remove the plunger from the 3mL syringe found in a CVC kit.
  • Shove the small end of the BVM connection off of a 7-0 ETT into the 3mL syringe where the plunger was inserted. 
  • Utilize the needle with angiocath that comes in the CVC kit to assure you can continuously aspirate while you advance the needle. 
  • This procedure is not definitive. It does not provide any ventilation. You still need to secure a definitive airway. 
  • Anesthesia, ENT, and General Surgery can all assist. The foreign body either needs to be removed or a surgical airway must be obtained. 

Deconstructing (Then Reconstructing) Your Presentation Slides by Haney Mallemat

  • Do you want to make more engaging and informative slides for your presentations? 

  • If so, then you definitely want to check out the free webinar this Thursday, March 11 at 6pmEST

  • Check out the post to register! 

You Want to Put That Contrast Where? by Ashika Jain

    • Indications for triple contrast in trauma patients
    • Triple contrast: oral, intravenous, and rectal administration of contrast
    • When is it indicated?

      • Penetrating torso trauma
      • Retroperitoneal injury

The Pediatric Airway: Tips and Insights by Samantha Dallefeld 

  • Remember the STOLEN mnemonic for the pediatric airway
  • Use Apneic oxygenation
  • Consider why certain laryngoscope blades are easier than others
  • Remember the equation for tube selection and tube depth
  • Use an opioid +/- an alpha-2 agonist or benzodiazepine for sedation and analgesia

SBI: Focus on Feedback by Zack Repanshek

  • Learn the SBI model (Situation, Behavior, Impact) and keep it in your pocket as a way to give effective feedback anywhere, anytime.

To Infuse or Not to Infuse (Insulin) by Rachel Rafeq

  • The mainstay therapy for DKA is a continuous insulin infusion for mild, moderate or severe cases.  

  • IV insulin infusions generally require intensive care unit level of care but mild DKA may not. Therefore, there may be an opportunity to utilize SubQ insulin to allow for reduced resource requirements and hospitalization costs without compromising clinical outcomes. 

  • The benefits of subQ insulin for DKA over IV insulin should be weighed against patient satisfaction.  

Proportional Assist Ventilation by Danelle Howard 

  • Allows patients neurophysiology to direct ventilation creating more natural breathing 
  • The ventilator and the patient share the work by setting a % support 
  • Estimates work of breathing and calculates respiratory mechanics determining how much support the patient needs

The Vitals: Trauma Induced Coagulopathy by Shyam Murali

  • Trauma-Induced Coagulopathy is a multifactorial process and a significant cohort of critically-injured patients have this condition as they enter our emergency departments.
  • Suspect this disorder in patients with systemic hypoperfusion (base deficit over 6 mmol/L), particularly in combination with high magnitude of injury.
  • Consider addressing and reversing some specific factors that may contribute to the coagulopathy, including temperature control, correcting acidosis, and repleting calcium

Is ECHO Mightier Than the Swan? by Matthew Tyler 

  • Measuring pulmonary artery pressures via echocardiography can provide useful data in the management of critically ill patients
  • Utilizing echocardiography may help avoid invasive procedures such as PA catheter placement
  • Echocardiography measurement of PA pressures is not as accurate as right heart catheterization but generates data acceptable for use in patients with pulmonary embolism, cardiogenic shock, right heart failure, and respiratory failure

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