Week In Review: 5/2/21

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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:

Utilizing CVP Waveforms to Assess the Intensity of Inspiratory Efforts by Aman Thind

  • The pressure measured with a CVC is the intramural CVP.
  • Inspiratory drop in CVP can be used as a surrogate for inspiratory drop in PPl/Pes
  • Inspiratory decline in CVP will systematically underestimate inspiratory drop in Ppl. This should be kept in mind while using it for assessing the intensity of inspiratory effort.
  • PCWP swings will more closely mirror Ppl swings. Note: a cut-off of 15 cmH20 has been used to define “significant inspiratory effort”.

Why ECGs in LVAD Patients are not Worthless by Andrew Phillips

  • ECGs in the presence of an LVAD have electrical interference but still provide valuable data including rate and dangerous rhythms.
  • Atrial fibrillation, ventricular tachycardia, and ventricular fibrillation are important arrhythmias that can be observed in ECGs in the presence of an LVAD.

Teaching the Rare & Life-Saving Procedure: Part 2 by Jenn Repanshek

  • Plan ahead when considering how to teach the rare and life-saving procedure. Highlighting the importance of reviewing the procedure prior to performing it and using simulation for procedural education are helpful ways to up your med ed game!

Pearls and Pitfalls with Push-Dose Pressors by Ruben Santiago

  • Push-dose pressors for the management of hypotension in the ED is becoming more and more common
  • Push-dose pressors have been used in the setting of transient hypotension, as a bridge to a vasopressor infusion, and during the peri-intubation period
  • Extreme caution should be used when using these medications to avoid medication errors and potential patient harm
  • Nicknames should be avoided when referring to vasopressors to decrease any confusion in which concentration is needed 
  • Communication is key in administering the vasopressor safely, avoiding medication errors, and optimizing pharmacotherapy
  • Double-check with your emergency department and pharmacy to see what is available and if any standards for the organization have been established

Know Your Autoflow! by Sabrina Kroft

  • Reduces high airway pressures while enhancing spontaneous breathing
  • Is the combination of pressure control and volume control ventilation
  • Improves ventilator synchrony

The Vitals: Summary of Task Force Report on Early Care of Adults With Suspected Sepsis in the ED by Shyam Murali

  • The care of our septic shock patients is extremely complex, and the first few hours matter the most
  • Identify sepsis early
  • Once sepsis is recognized, prompt action to treat infection and reverse or prevent hypotension and hypoperfusion is important
  • Give fluids, but personalize the volume of fluid administration to the needs of your patient. Use dynamic measures of assessment, instead of static measures, to determine which patients need more IV crystalloid.
  • Monitor your patients closely and adjust the treatments based on the patient’s response
  • Give antibiotics early, but there is not enough data to support a specific time frame in which to give it
  • Vasopressors can be given through a good peripheral IV for short periods

A Ride Through Right Ventricular Assessment Part 2 by Segun Olusanya and Korbin Haycock

  • Check out this video where Segun and Korbin discuss some more advanced ultrasound techniques to assess the RV function

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