Week In Review: 4/25/21

Reading Time: 2 minutes
Melina Alexander
Melina Alexander
St. Vincent's Emergency Medicine Resident, PGY-1

For some spaced repetition, here’s a review of this week’s content:

Trauma Chest Tubes: Bigger Is Not Always Better by Zaf Qasim

  • Most trauma patients with hemothorax do not require large chest tubes
  • More emerging evidence supports the use of 14-French pigtail catheters as opposed to larger, traditional chest tubes
  • The drainage rates and incidence of complications appear to be at least equal, and your patient may well thank you for using the smaller tube

SCCM Guidelines for Acute and Acute- on-Chronic Liver Failure by Fraser Mackay

  • ALF and ACLF are challenging entities, but they continue to be common causes of ICU admission, with sometimes prolonged stay. ALF and ACLF often have multi-system dysfunction, but often patients will respond to common critical care support modalities. The SCCM guidelines provide some insight into some key day-to-day critical care interventions that seem to work. 

Performance Skills for the Educator: Power of Practice by Jenny Beck-Esmay

  • Practice is a skill that itself must be practiced.  Before any presentation, rehearsal must take place many times over and out loud.  Seek feedback, either through modalities in which you assess yourself or if possible from a friend or colleague.  Each time you deliver your presentation, seek feedback from your audience.  Consider scripting high-impact moments of your talk, but in your rehearsal play around with some improvisation so you remain nimble in your final delivery. 

Meds to Avoid with Myasthenia Gravis by Nishika Patel 

  • Patients with MG may develop MG crisis in which admission to the ICU is typically necessary.
  • Knowledge of medications/medication classes to avoid when possible is essential to prevent further disease damage in MG patients.
  • When using paralytics in MG patients, remember to dose adjust accordingly. The dose of depolarizing paralytics such as succinylcholine should be increased by 2-2.5x’s. The dose of nondepolarizing paralytics such as rocuronium, should be decreased by 50-90%.
  • Risk versus benefit should be considered carefully when using a medication that could worsen MG; alternative treatments should be considered.

Non-Invasive Open Ventilation by Linda Melchor

  • A reduction in hospital readmissions could possibly be decreased with increased use of NIOV
  • NIOV can improve quality of life and ADLs in qualifying diseased patients
  • Pulmonary Rehabilitation can improve the quality of life in patients with lung diseases

The Vitals: Pulsus Paradoxus by Obiajulu Anozie

  • Pulsus paradoxus should not be used primarily for diagnostics; it is non-specific. However, when discovered it should be viewed as a warning sign for the presence of a serious physiological disturbance that should be investigated further.

SAM & The Wicked Case of Obstructive Shock by Matthew Tyler

  • SAM: Systolic Anterior Motion
  • Movement of mitral valve leaflets, more commonly the anterior leaflet, into the LVOT during systole
  • Most common condition that causes SAM is hypertrophic cardiomyopathy (HOCM), the incidence of which is 1/500 in the general population
  • If LV wall thickness during diastole is > 15 mm, then the patient likely has HOCM
  • Shock like patients…throw a probe on the heart and look for SAM.


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