Reading Time: 2 minutes
Melina Alexander
St. Vincent's Emergency Medicine Resident, PGY-1
For some spaced repetition, here’s a review of this week’s content:
ED Awareness Study by Allan Lai
- Â Nurses have the most influence on post-intubation and sedation
- Ask for both analgesia and sedation medications and determine the dose titration range
- Assess what the needs for analgesia and sedation; if the patient is a trauma patient, chances are they would need higher doses of analgesia and sedation than a patient who is intubated for a medical reason
Skewed Sats: Limitations of Pulse Oximetry by Steve Haywood
- Pulse oximetry allows us to monitor oxygenation levels without repeated blood gas sampling. However, we must know when we can and cannot trust a pulse oximeter.Â
- Patients with dark skin are more likely to have occult hypoxemia when monitored by pulse oximetry.
- Patients with hemoglobinopathies such as carbon monoxide poisoning or methemoglobinemia will have an inaccurate pulse oximeter reading.Â
- When distal extremities are hypoperfused, the pulse oximeter may be incorrect. Always confirm a good waveform on your monitor.Â
- At hemoglobin saturations below 80%, the pulse oximeter may be underestimating the SaO2.Â
- When in doubt, check an ABG
ED Awareness Study by Allan Lai
- Nurses have the most influence on post-intubation and sedation
- Ask for both analgesia and sedation medications and determine the dose titration range
- Assess what the needs for analgesia and sedation; if the patient is a trauma patient, chances are they would need higher doses of analgesia and sedation than a patient who is intubated for a medical reason
Phil Rola: Musings on TCAV-APRV by Phil RolaÂ
- Check out this video to learn more about TCAV-APRV!
Be a Coach by Zack Repanshek
- So be a coach. You do not need a whistle or a clipboard, only an investment in your learner’s development and a willingness to share your expertise.
Open Fracture From Open Waters by Ruben Santiago
- Infection rates of wounds exposed to saltwater or freshwater are much higher than those of terrestrial injuries
- Always consider the environment in which an open fracture has occurred to assist in selecting the most optimal antibiotic regimen
- In patients exposed to a saltwater environment, antibiotic coverage should be aimed for Vibrio spp and consists of a third or fourth generation cephalosporin in addition to doxycycline
- In patients exposed to a freshwater environment, antibiotic coverage should be aimed for Aeromonas hydrophila and consists of agents that target Pseudomonas aeruginosa such as a third or fourth-generation cephalosporin or a fluoroquinolone (i.e. ciprofloxacin or levofloxacin)
- While special attention is needed in covering these bacteria with the appropriate antibiotics, typical skin flora such as Staphylococcus aureus and Streptococcus pyogenes are still the most common pathogens overall in saltwater and freshwater exposed open fracture
Ventilator Management of Persistent Air Leaks by Gene Macogay
- The presence of persistent air leaks complicates ventilator management
- Air leaks are associated with increased morbidity and mortality
- Identification, monitoring, proper ventilator settings and management are key in minimizing air leaks and optimizing care for patients with air leak.
