For some spaced repetition, here’s a review of this week’s content:
A Better Offense: Preventing Peri-Intubation Hypotension by Terren Trott
- Consider the pathophysiology specific to your patient, choose an intubation strategy to protect your patient from hemodynamic collapse
- Choose ideal induction agent that fits your intubation and hemodynamic needs
- Consider early and aggressive use of vasopressors to mitigate hypotension
Neurogenic Shock by Mohamed Hagahmed
- Neurogenic Shock is a diagnosis of exclusion. Consider it in your trauma patient with unexplained hypotension and bradycardia after ruling out hemorrhage or other internal injuries (Tension Pneumothorax, Pericardial Tamponade, etc.)
- In elderly patients, factors such as medications (Beta Blockers) or age-related neurocognitive deficits can mask the severity of their symptoms. Maintain a low threshold for considering spinal injuries in these patients.
Acute on Chronic Liver Failure in the ICU: Part 1 by Fraser Mackay
- ACLF is a complex disorder that requires early recognition and treatment. Check out Dr. Mackay’s post to learn how to identify and risk stratify it.
- Beware the ACLF spiral of death
The Many “Flavors” of Doppler by Gurkeerat Singh
- The Doppler effect is utilized in ultrasound to detect movement of blood towards and away from the ultrasound probe
- Check out the post to learn how to best use Color Doppler, Continuous Doppler, Pulse Wave Doppler, and Tissue Doppler.
The Vitals: Pulmonary Artery Catheter by Tim Montrief
- The PA catheter can provide you with some valuable information about your patient including, but not limited to:
- Right atrial pressure
- Right ventricular pressure
- Pulmonary artery pressure
- Pulmonary capillary wedge pressure
- Cardiac output
Drugs, ECMO, & Rubber Ducks by Lauren Igneri
- ECMO can alter the pharmacokinetics and pharmacodynamics of medications
- Just think of the ECMO circuit as a full bathtub with rubber ducks and a pesky clog!
AKI and Arterial Intra-Renal Doppler (IRD) by Eduardo Argaiz
Doppler waveform of flow of the inter-lobar vessels of the kidney can be used to calculate de Renal Resistive Index (RRI)
Monitoring the change in RRI could provide real-time (immediate) feedback to determine the effectiveness of resuscitation efforts
Increased RRI has been linked with AKI and RRI can be modified with resuscitation strategies like vasopressors or fluids
Although mainly determined by pulse pressure and compliance, intrinsic resistance vascular can also alter RRI