Week in Review: 8/2/20

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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:

PRVC: Pearls & Pitfalls by Matt Siuba

  • PRVC is an adaptive form of pressure control that allows the patient to control flow, while still targeting a set tidal volume by adjusting the provided inspiratory pressure
  • This can be beneficial if the patient is weaning, and detrimental if work of breathing is very high, as they will receive little or no support

You Want to Put That Contrast Where? by Ashika Jain

  • Triple contrast CT scan includes oral, intravenous, and rectal contrast
  • Consider it for penetrating torso trauma and retroperitoneal injury
  • Helps to identify peritoneal violation/injury or vascular injury
  • Dilute 400-750cc water with 50cc water-soluble contrast. Administer the contrast via enema of a foley catheter.

Pediatric Airway: Tips and Insights by Samantha Dallefeld

  • Remember the STOLEN mnemonic for the differences between the pediatric and adult airways
  • Remember to use apneic oxygenation
  • Blade selection is a personal preference, but the Miller blade is designed to lift the floppy pediatric epiglottis out of the way
  • VL may improve first pass success

UltraRounds: Movements of the Probe by Siri Chamarti

  • The six ultrasound probe movements include:
    • Slide
    • Rock
    • Sweep
    • Fan
    • Compress
    • Rotate

The Vitals: The Deep Breath by Sunil Ramaswamy

  • A brief pause will quiet your mind. A quiet mind thinks effectively.
  • Panic is the enemy of the resuscitationist
  • Never be afraid to ask for help

Better Than a Benzo by Lauren Igneri

  • Weight-based loading doses of phenobarbital promote rapid alcohol withdrawal (AWD) symptom control
    • Medium risk of AWD with severe risk of respiratory compromise: 6-8mg/kg Phenobarbital loading dose
    • High risk of AWD with minimal risk of respiratory compromise: 12-15mg/kg Phenobarbital loading dose
    • When in doubt, use 10mg/kg

Midodrine in the ICU by Eddy Joe

  • Midodrine can potentially help wean patients from IV vasopressors and decrease length of stay in the ICU


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