Week in Review: 8/23/20

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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:

All That “Bladerdash” by Viren Kaul

  • Mac and miller blades are introduced in Rose/sniffing position while hyperangulated blades are deployed with the neck in neutral position
  • Tip of the Mac blade should be placed in the vallecula, while the Miller blade in positioned under (posterior) to the epiglottis
  • A “great” view with the hyperangulated blade can lead to difficult tube introduction: “The objects are closer than they appear on the screen!”

Blunt Cerebrovascular Injury (BCVI) by Zaf Qasim

  • Suspect BCVI in your blunt multi-trauma patients, as missing this injury carries significant risk of stroke and/or mortality
  • Complex head, neck, and thoracic injuries should raise your suspicion for this injury
  • Add a CTA of the neck to screen for BCVI in addition to other indicated imaging
  • Early consultation with trauma and neurosurgical services allows tailored treatment

Consequences of Cardiopulmonary Bypass by Colin McCloskey

  • Cardiopulmonary bypass allows an arrested heart and a bloodless field for cardiac surgical procedures
  • The insults of cardiac surgery, cardioplegia, and the non-physiologic state of CPB cause a predictable cascade of pathophysiological effects that lead to end organ complications.

#WhatsTheDx? Question and #WhatsTheDx? Answer by Haney Mallemat

  • Check out this incredible case and try to figure out what caused it!

The Vitals: Oxygen Delivery Equation by Shyam Murali

  • Break down the delivery of oxygen equation into its components and learn about how to optimize each part in your crashing patient
  • Important parameters to optimize include: stroke volume, heart rate, hemoglobin, and SaO2.

Tandem Codes: A Novel Cardiac Arrest Care Model in COVID-19 by Harman Gill

  • Here’s a new cardiac arrest management paradigm in which a physician and nurse work in tandem to provide the best care for the patient, while keeping the staff safe.
  • Make sure to practice this model in the sim lab as well as in situ

How to Become a Diuretic Ninja by Sharad Patel

  • There are many strategies to fluid diuresis:
    • Attain negative sodium and fluid balance while augmenting the correction of hyperkalemia and acidemia
    • Attain negative sodium and fluid balance correcting hyponatremia and acidemia
    • Achieve a negative sodium balance while preventing further hypokalemia and alkalemia
    • Achieve negative sodium balance while preventing further hypokalemia, alkalemia, and hypernatremia


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