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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
