Week in Review: 3/21/21

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

Bougie First Intubations by Terren Trott

• This was a single-site, pre-post intervention study where bougie became the initial method of intubation compared to ETT and stylet.
• This study confirms prior studies that have shown higher first pass success when using a bougie-first method.
• This study also gives insight into the utility of the bougie during cardiac arrest, an inherently difficult intubation scenario which represented nearly half the patient population.

Close the Book and Pay Attention: Stabilize Pelvic Fractures by Mohamed Hagahmed 

• Trauma patients with unstable pelvis have high morbidity and mortality
• Stabilize pelvic fractures with any available commercial devices, or by using a bedsheet
• The bedsheet should be wrapped around the greater trochanters
• Definitive therapy for unstable pelvic fractures is with external or internal fixation, and angiographic embolization

Introduction to ROTEM (Part 1 of 2) by Fraser Mackay

• ROTEM is a viscoelastic assay that may be a helpful adjunct to caring for patients in specific circumstances during their resuscitation or ICU course. 
• Consider using ROTEM in the following scenarios:
  • Large scale blood resuscitation (MTP activation)
  • Unexplained bleeding episodes
  • Pre, peri, and post-operative and courses for liver and cardiothoracic surgery cases
• ROTEM may not screen for all illnesses. Use with caution when trying to manage or diagnose conditions like hemophilia, ATIII, FVL, or with DOACs
• ROTEM (or any VEA) only helps if you have a strategy to help you get through the waveforms and parameters. Hematology experts may not be able to help you here. For a nitty-gritty break down and some help with strategy, see Part 2.

Performance Skills for the Educator: Advanced Preparation by Jenny Beck-Esmay

• Gather information about the makeup of your audience and tailor your presentation to their specific needs.
• As early as possible, become familiar with the physical venue in which you will be presenting.  This will allow you to rehearse for that space and ease some jitters.
• Ask about the specific technology setup you can expect, specifically which file format will be accepted for your slides, whether a presenter remote will be provided and what type of microphone can you expect.

Gastrointestinal Hiccups in the ICU by Nishika Patel 

• Gastroparesis, constipation, and functional ileus are 3 gastrointestinal issues that are commonly encountered in the ICU.
• The mechanical obstruction which would necessitate surgical intervention should be ruled out before initiating pharmacological treatment.
• While limited literature exists in critically ill patients, current data suggest that the use of PAMORAs for opioid-induced constipation, specifically methylnaltrexone, may increase the risk of mortality.

Pediatric Endotracheal Tubes by Tammy Dutch

• Cuffed endotracheal tubes are recommended in the pediatric population as the initial tube choice.
• The size of a cuffed ETT is the (patients age)/4+3.
• Always use a length based tape if there are questions or doubts.
• A quick estimate for tube depth is (Size of the ETT)x4.

The Vitals: Understanding the Respiratory Drive by Obiajulu Anozie

• The primary purpose of the respiratory system is to effectively oxygenate the tissues and eliminate carbon dioxide.
• In the setting of disease, changes in the physiological environment can influence the intensity of signal output from the respiratory centers, dramatically affecting the respiratory drive.
• In the next article we will explore the impact of critical illness on the respiratory drive and its implications on clinical outcomes.

A Ride Through Right Ventricular Assessment by Segun Olusanya and Korbin Haycock

• Assessing right ventricular function through ECHO
• Assess size of the ventricles with the rule of thirds 
• RV inflow view to assess for tricuspid regurgitation