Week In Review: 6/27/21

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

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

SALAD for Nurses by Alyx Presler 

  • SALAD is for nurses too!
  • Clean out that contaminated airway with a reverse grip holds on a suction catheter. Get that tongue out of your way.
  • Then pick your poison: OPA, LMA, BVM

The Crashing Patient in the Prehospital Setting: Reducing Post EMS Contact Cardiac Arrest By Simon Taxel 

  • Rapid extrication and transport of critically ill medical patients are dogmatic in prehospital care. However, they are not supported by high-quality evidence.
  • For some patients, rapid transport before stabilization may increase the likelihood of cardiac arrest and poor outcomes.
  • A crashing patient bundle of care that prioritizes airway management, ventilation, and hemodynamic support prior to patient movement substantially reduces the incidence of post-EMS contact cardiac arrest.  
  • It may be challenging for clinicians, especially those who have been practicing for many years, to break old habits and make substantive changes to their practice. Successful implementation of a crashing patients bundle of care requires a great deal of simulation training as well as targeted education to increase knowledge and buy-in. 

Birds of a Feather By Danya Khoujah

  • Mentoring URM is an important step to further their career and improve the workplace for all. In addition to being available to serve as a mentor, implement the following steps:

    • Be humble about what you don’t know
    • Create a safe space for connection, mentally and physically
    • Depersonalize some of the interactions and use them to grow

Hydroxycobalamin in Fire Related Cyanide Toxicity by Rachel Rafeq 

    • Patients presenting with altered mental status or soot around the mouth, nose or oropharynx, after being exposed to fire smoke in an enclosed area may benefit from hydroxycobalamin.
    • Hydroxycobalamin is dosed as 5 g over 15 minutes. A second dose may be administered up to a max of 10 g. 
    • Hydroxycobalamin will cause urine discoloration which can last up to 5 weeks, however is not harmful and should not result in therapy discontinuation.

The Vitals – Lactated Ringers (Part 1) by Jon Pickos

  • LR is SAFE in hyperkalemia and likely preferred over Normal Saline because of the ensuing acidosis caused by large volume chloride infusion leading to worsening extracellular hyperkalemia.
  • Furthermore, the potassium concentration in LR does not cause an extracellular rise in potassium levels and is more likely to cause a trend towards 4mEq (the same amount within LR)

Scanning For Upper Extremity DVT by Siri Chamarti 

  • Consider Upper Extremity DVT as a diagnosis in patients presenting with arm pain with a history of previous thrombi.
  • Scan vessels of the neck and arm with compression sonography to further evaluate for DVT.
  • If compression ultrasonography cannot be performed, apply color or power doppler to assess for DVT

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