Week in Review: 7/26/20

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Picture of 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:

Foundations of Synchrony by Steve Haywood (Video Review)

  • In patient-ventilator dyssynchrony, attempt to optimize the ventilator to synchronize with the patient instead of optimizing the patient to synchronize with the ventilator
  • For tachypneic patients, consider a higher I:E time ratio (1:2 or even 1:1)
  • For patients with obstructive lung disease a lower I:E time ratio to allow for full expiration
  • Read the article to learn about calculating the I:E ratio

Changing the Alphabet Soup of Trauma Resuscitation by Zaf Qasim

  • Control catastrophic hemorrhage and resuscitate with blood (if possible) before you intubate the bleeding trauma patient
  • Use basic airway maneuvers to support the airway while addressing the first C’s

Classic Studies in MCS: The REMATCH Trial, 2001 by Colin McCloskey

  • The Rematch Trial (2001) laid the evidentiary foundation for LVADs as destination therapy
  • Survival at one year favored the LVAD group (52%) over optimal medical therapy (25%), with a NNT of 3.7

The ABCT’s of CT Imaging (Part II) by Rupal Jain

  • Hounsfield unit of blood is approximately 50
  • CT Angiography is not the same as CT with IV contrast
  • For CTA, the patient will need a power-injectable line

The Vitals: Blood Pressure by Jeremy Greenberg

  • Each component of the blood pressure (SBP, DBP, MAP, PP) should be viewed as a specific hemodynamic surrogate, and can help us to craft a detailed picture of the underlying circulatory physiology

Intubating Patients with COVID by Harman Gill

  • Remember the 5 P’s for the COVID airway: Prepare, Providers, Pre-Ox, Perform, Practice
  • The most experienced operator attempts airway in a negative pressure room with appropriate PPE; VL first with complete RSI
  • Develop your own protocol for airway bags, teams, and processes in surge and routine situations
  • HFNC with a level 2 surgical mask or NIV with HME filter is preferred mode for pre-ox
  • Only BVM with 2-hand technique
  • Practice, practice, practice. In-situ simulations rock with your entire team.

Pregnant Patients with Respiratory Distress by Kami Hu

  • Pregnant women:
      • have challenging airways due to airway edema and narrowing
      • are at increased risk of aspiration
      • have decreased pulmonary reserve
      • have increased metabolic demand and oxygen utilization
  • Oxygenation and ventilation goals are different than the general population
  • NIPPV is not contraindicated
  • Use a smaller than usual endotracheal tube
  • Use apneic oxygenation and head up intubation to prevent rapid desaturation

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