Week In Review: 9/05/21

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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:

Can We Predict Trauma-Induced Caogulopathy? by Shyam Murali

  • This study, with a moderately-sized subject population, demonstrated that patients with trauma-induced coagulopathy and hyperfibrinolysis can be identified at the site of injury. We look forward to seeing future studies that investigate the clinical impact of this information and how we can help more patients in the prehospital setting.

A Guide to High Frequency Percussive Ventilation: VDR-4 by Danelle Howard

  • Now that you know how the VDR can be utilized, let’s look at it’s set up. High frequency percussive ventilation can be intimidating to initiate but with these quick guides and go to operational sheets the o pneumatics can be conquered.

Naloxone in Opioid Induced Cardiac Arrest by Rachel Rafeq

  • There is proven benefit for the use of naloxone in patients who have suffered respiratory depression but continue to have a pulse
  • The evidence for naloxone benefit in patients who have arrested and are pulseless is not compelling
  • As per AHA guidelines, the most important intervention in opioid-associated cardiac arrest is high-quality chest compressions and ventilation. The use of naloxone is unlikely to provide benefit.

Vulnerability in Medical Education by Danya Khoujah

  • Vulnerability is not weakness. Vulnerability is putting yourself out there, sharing your creativity and desire for change with the world, which is essential for any medical educator. 

Ventilator Basics by Alyx Presler

  • A/C mode has a set RR and Vt (or inspiratory pressure paired with inspiratory time in pressure control)
  • SIMV mode has a set RR or Vt (or inspiratory pressure paired with inspiratory time in pressure control); any breaths above the set RR are delivered as “pressure support” breaths.
  • PSV mode has no RR or Vt set, be mindful of work of breathing. CPAP, unlike PSV, has set inspiratory pressure of zero.
  • Settings to alter oxygen are FiO2 and PEEP, to alter carbon dioxide are RR and Vt 
  • Find the 100% FiO2 button
  • If equipment failure is suspected USE A BVM

Nine Reasons to Rethink APRV for Your Hypoxemic Patient by Komal Parikh 

  • While APRV has its advantages, the disadvantages of this mode may outweigh the benefits of using it on your patient. Think about your patient’s clinical situation, acid-base, and volume status prior to initiating the mode, and always monitor your patient’s hemodynamics and get a blood gas 30 minutes to one hour after starting this mode to assess if any changes need to be made.

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