Week In Review: 8/22/21

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Picture of Melina Alexander
Melina Alexander
St. Vincent's Emergency Medicine Resident, PGY-1

For some spaced repetition, here’s a review of this week’s content:

Get Ready for the Critical Care Lounge by Haney Mallemat 

  • The Critical Care Lounge is a new live video series where we talk critical care with the experts to see how they do things at the bedside.
  • Check it out! 

Hyoepiglottic Ligament and Midline Vallecular Fold by Terren Trott

  • The midline vallecular fold has anecdotally been the target for the tip of your mac blade yet no clinical studies have addressed the efficacy of engagement.
  • In a retrospective review, engagement of the fold yielded more frequent good Cormack-Lehane score.

Arterial Line Insertion and Waveforms by Tyler Jones

  • What’s the reason/indication for the arterial line and is it appropriate? Remember that unnecessary a-lines can lead to infection
  • The setup is key
  • Prime tubing before successful placement and make sure the pressure bag is inflated correctly.
  • Know your waveforms and how to troubleshoot them.
  • If unsure what is going on with waveform, complete a flush test and troubleshoot with your newfound knowledge.

Does LR Worsen HyperK? Not if You’re Smart About it! by Fraser MacKay

  • The number of patients fitting their definitions was pretty small (187 patients with hyperkalemia and 1,324 patients with AKI). That having been said, they had some cool findings that largely favors balanced crystalloids in these subgroups:

    • Worsening hyperkalemia: No difference between groups
    • Worsening AKI: Patients in the balanced crystalloid group had significantly less AKI than those in the normal saline group (aOR = 0.47)
    • Need for new RRT: patients in the balanced crystalloid group needed new RRT much less frequently (aOR 0.4)
    • If someone had acute-on-chronic kidney injury, their need for RRT was similarly reduced if they received balanced crystalloid rather than normal saline (aOR 0.69)

Much More Mucor by Mike Tom

  • Mucormycosis is a rare and devastating fungal infection that is currently spiking in association with COVID-19 in India and many parts of the world  
  • Mechanistic linkage is unclear but likely related to increased steroid use and altered immune state in diabetic patients
  • Judicious use of steroids and immunomodulators for COVID-19 is important to avoid further immunocompromising select populations for secondary infections
  • The primary treatment for Mucormycosis is early and aggressive surgical debridement with concurrent liposomal amphotericin B
  • HBOT can be considered as adjunctive therapy for mucormycosis if available 

The Slow Approach to Airway Obstruction by Stephen Biehl 

  • FEV1/VC is used to determine the severity of obstruction in patients
  • The FVC can cause air trapping, preventing the complete exhalation of the VC in order to calculate the FEV1/FVC properly


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