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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:
Ventilating Asthma or COPD? I:E is not the Goal by Steve Haywood
- Intubated patients with severe obstructive lung disease can be some of the most challenging to manage. Continue to dose albuterol and treat the underlying disease.
- You may have to hit the reset button while you optimize the ventilator.
- You may be able to increase the tidal volumes if the plateau pressures are low.
- As paralytics are added and spontaneous inspiration is removed, the respiratory mechanics change and turbulent flow may be reached at higher inspiratory times.
- The rate may need to be lower even more. As you treat the disease, you may be able to increase the rate.
- Look at your I:E ratio. You need to get it low (1:5 or lower), but do not fixate on it. It is all about giving the patient as much time as possible to exhale.
Pulse Checks in Cardiac Arrest by Jeff Pepin
- Palpation: should go the way of the rotary phone
- ETCO2: most practical with few limitations
- POCUS Pulse Check: Newcomer on the block with some limitations
- TTE: Gold standard but has limitations
- TEE: Awesome when used appropriately and available
- Arterial line: Great if you have the time
Outcomes for Septic Shock Survivrs: ADRENAL Follow-up by Fraser Mackay
- Hydrocortisone does not affect quality of life for sepsis survivors.
- Among septic shock survivors in the ADRENAL study, at 6 month follow up:Â
- 20% had moderate to severe disability
- Only about 50% felt they were disability free
UltraRounds: Knobology by Segun Olusanya
- Pearl #1: Good image quality is not just helpful for you to make better diagnoses, but for everyone to be able to make those diagnoses with you.
- Pearl #2:Â Have what you are looking for in the center of the screen, as big as possible, and as smooth and as clear as possible.
- Pearl #3:Â Think about depth, gain, focus, and sector width every time you are imaging a body structure.
The Vitals: Central Venous Pressure by Michael Javid
- CVP is not appropriate for guiding fluid therapy; there are numerous other methods to assess for fluid responsiveness
- Consider using it when you are concerned for right ventricular function
A Push for a (First-Dose) Push by Rachel Rafeq
- IV push is likely a feasible option for the first dose of antibiotics
- Speak with your pharmacists to ensure that the concentration is less than 900mOsm/L
- Check out the post for a handy chart that helps you convert common antibiotics into push-dose versions!
More Bad News About COVID-19 by Puja Singh
- COVID-19 may have a link to Guillain-Barre Syndrome so be on the lookout for signs and symptoms concerning for GBS
