Week In Review: 7/11/21

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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:

External Laryngeal Manipulation by Terren Trott

  • External laryngeal manipulation is a key skill in airway management and has been shown to improve glottic visualizaiton in multiple studies.
  • ELM can be enhanced with two-operators and video laryngoscopy, allowing the second operator to help in visualization

A Summary of the PALS 2020 Updates by Samantha Dallefeld

  • Assisted ventilation rate of 1 breath every 2-3 seconds for ALL pediatric resuscitations.
  • Cuffed ETTs are always recommended.
  • Routine cricoid pressure during intubation is NOT recommended.
  • EARLY epinephrine administration in the setting of cardiac arrest from a non-shockable rhythm improves outcomes.
  • Diastolic blood pressure on an arterial line can improve CPR quality, target >25mmg in infants and >30mmHg in children.
  • After ROSC, evaluate for seizures.
  • Formal psychosocial assessment is needed post-arrest.
  • For septic shock, administer 10-20ml/kg aliquots of fluid and reassess.
  • Epinephrine and norepinephrine are superior to dopamine in septic shock resuscitation.

Was Your Evaluation Biased? by Danya Khoujah

  • Think of the following biases before you hit submit (or sit down for that conversation): halo, contamination, contrast, and confirmation.
    • Take a moment and ask yourself: 
      • Is my evaluation based on what I saw or on other things (likeability, unrelated facts, preformed opinions, etc)?
      • Am I comparing my learner to someone else instead of a “standard”?

There’s Something Fishy Going on Here by Ruben Santiago 

  • CFP is the most common fish poisoning both worldwide and in the United States
  • CTXs are tasteless, colorless, odorless, heat and acid-stable, and stable for at least six months at commercial freezing temperatures
  • CFP is not due to mishandling and is not prevented by any storage, handling, or cooking method
  • Clinical diagnosis of CFP consists of presenting symptoms, time course, history of eating reef fish, and the exclusion of other diagnoses
  • Management is largely supportive, with consideration given to mannitol for acute presentations 
  • Mannitol is normally dosed at 0.5 – 1 g/kg for this indication (more commonly 1 g/kg) and infused over 30 – 45 minutes 
  • Consult your poison center at 1-800-222-1222 when these patients present.

VAP Sucks Subglotically by Seon Adams and Rahel Gizaw

  • Subglottic tubes are effective in reducing VAP by allowing easy secretion management despite not reducing mechanical ventilation days and ICU length of stay.
  • These endotracheal tubes are not widely implemented in the ICU due to cost, controversy of tracheal mucosal injury, the variability of subglottic secretions, and limited studies. 
  • Review RT’s Zap VAP for more tips in reducing VAP.

An Introduction to Ventilator Terminology by Bassam Zahid

  • When working in the emergency department or the ICU, it is not enough for medical students, nurses, residents, and non-intensivists to secure the airway and ignore how the ventilator works.
  • After intubating a patient, understanding what settings to select based on their specific physiology will likely lead to better outcomes.
  • The names of some settings are copyrighted so that the same settings on different machines will have different names. It is important to know the ventilator you are working with.
  • Opinions vary on optimal ventilator settings. Take the best of what everyone will teach you and determine your own practice. Read the literature, apply your knowledge, ask questions, trust but verify, and keep an open mind.

Lateral Thinking on CXR by Rupal Jain

  • Reviewing the lateral CXR and the benefit of obtaining the orthogonal view to the frontal radiograph. 

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