Week In Review: 5/23/21

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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:

How to Handle the Handle by Steve Haywood

  • An expert proceduralist holds the blade close to the hinge.
  • An expert proceduralist holds the handle more in the fingers than the palm
  • An expert proceduralist keeps the handle at an angle much less than 45 degrees when compared to the table.

Heparin Monitoring on ECMO: Xa vs aPTT by Colin McCloskey

  • ACT, anti-Xa, aPTT, and TEG are all viable but flawed monitoring options for heparin anticoagulation. 
  • In this before and after chart review, anti-Xa levels led to less heparin exposure and more time in a therapeutic range than aPTT driven anticoagulation
  • More robust study designs with greater sample sizes are needed to improve our understanding of which monitoring test to use in ECMO patients

Common Medications Administered via Intranasal Route by Rachel Rafeq

  • Intranasal route of administration serves as an excellent alternative to IV or IM administration for certain medications as it is non-invasive, does not require a needle, and results in a quick onset of action
  • Medications that may be administered intranasally include but are not limited to fentanyl, ketamine, midazolam, and naloxone.

What the Affinity? – Hemoglobin Oxygen Affinity by Sabrina Kroft

  • pH, temperature, CO2, 2,3-BPG, and CO are factors that affect the affinity of hemoglobin to oxygen 
  • Increasing the affinity of hemoglobin to oxygen shifts the curve to the left, ultimately delivering less oxygen to the tissues. 
  • Decreasing the affinity of hemoglobin to oxygen shifts the curve to the right, ultimately delivering more oxygen to tissues.

The Vitals: High Stakes Communication in the ICU by Sunil Ramaswamy

  • We know how stressful being a leader is, especially when taking care of critically ill patients or patients deteriorating right in front of your eyes. During these moments, we hope that the points brought up in this article will help you lead your team effectively through these situations and help keep your patients alive.
  1. Keep a calm mind during the most stressful situations.
  2. Keep open communication flowing among the team and delegate tasks effectively.
  3. Do not react in anger to perceived mistakes, especially in front of a crashing patient.
  4. Remain open to suggestions without being too full of pride. Ask for help when it is needed.

Let’s Get Moving: Probe Movement by Siri Chamarti

  • The six ultrasound probe movements include:
    • Slide
    • Rock
    • Sweep
    • Fan
    • Compress
    • Rotate


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