For some spaced repetition, here’s a review of this week’s content:
Hyperangulated Hiccups by Jonathan Hootman and Brock Hashim
Hyperangulated VL is a fantastic weapon in our armanament, but comes with its own unique set of challenges compared to DL. Use the these tips to step up your next hyperangulated intubation.
Transcutaneous Pacing for Nurses by Alyx Presler
- AP electrode positioning
- KNOW YOUR MONITOR
- Don’t forget to assess for mechanical capture
- Adequately manage pai
Pan Scan CT? Not Just for Trauma by Zaf Qasim
- Pan-scan CT post-OHCA may identify causes of the arrest not immediately evident by other routine investigations in a small number of cases.
- Time-critical problems do occur (either causing the arrest or as a result of the resuscitation) and the CT scan protocol may be useful in the early identification of this.
- The described protocol is relatively safe.
- Further prospective randomized study is necessary to determine the usefulness of this approach on outcomes
In Situ Airway Education by Jenn Repansheck
Consider adding one-on-one in situ airway management sessions to your teaching arsenal to improve the effectiveness of your education, increase the confidence and success of your learners, and decrease your educator excitement level during their first real-life intubation!
Life Without Blood by Mike Tom
- Addressing the underlying cause (i.e. hemorrhage control in trauma) is still the first priority in the severely anemic patient
- HBOT can be a bridge or temporizing measure in cases where blood transfusion is refused or otherwise not an option
- Given the dramatic change in PaO2 in hyperbaric conditions, oxygen dissolved in plasma plays a much greater role in affecting total arterial oxygen content when compared to normobaric conditions
- HBOT is one of MANY adjunctive and alternative treatment options which can be considered for severe anemia in the patient refusing or unable to receive blood transfusion
The Extubation Series Part 2: Trials of Weaning Failure by Danelle Howard
- Reintubation is associated with 7-11x increase in hospital mortality
- Approximately 10-15% of all extubated patients require reintubation
- Use of ABCDE model may expedite weaning from mechanical ventilator
- Patient treatment specific strategies to optimize weaning
The Vitals: Pulling the Tube – Advanced Techniques, Tips, and Tricks by Sunil Ramaswamay
- Listen to the respiratory therapist! A good RT is an ESSENTIAL part of the ICU team, and you must incorporate their input into your rounds. They have the best knowledge of the patient’s respiratory status. Check in with the RT often – If the RT is worried, you should be worried too!
- Dry lungs are happy lungs! Try to keep your patient’s fluid balance net negative in the ICU. This is especially true if the primary reason for your patient’s respiratory failure was due to pulmonary edema.
- 30 minutes of SBT on pressure support is PROBABLY enough for you to make a determination about your patient’s readiness to be extubated.
Every clinician will have their own recipe for judging readiness for extubation. Listen and learn from everyone, and then find a method that works for you.
- LISTEN TO THE RESPIRATORY THERAPISTS!