For some spaced repetition, here’s a review of this week’s content:
Lung Mechanics Stressing You Out? by Terren Trott
- Stress on the lung parenchyma is the restoring force per unit of area; it has units of pressure. Practically, the best surrogates of parenchymal stress are end-inspiratory and end-expiratory transpulmonary pressures.
- Strain is the degree of deformation of the lung and is often reduced to tidal volume.
- Appreciation of these basic concepts allows one to have a deeper understanding of the various pathophysiological aspects of VILI.
Why >7.0 g/ml by Tyler Jones
- Know your patient’s current and past medical history to appropriately assess their transfusion threshold.
- Keep >7.0 g/dl in non-cardiac and orthopedic surgery patients.
- Those undergoing orthopedic surgery, cardiac surgery, pre-existing cardiac disease or active cardiac disease transfuse for > 8.0 g/dL.
- Know the adverse reactions to transfusions.
- Consider suggesting electrolytes for patients receiving massive transfusion
Can I Dive After COVID? by Mike Tom
- Cardiopulmonary demands in underwater environment merit careful evaluation of patients in order to deem fit for diving.
- Although unclear at this time, sequelae of COVID-19 may predispose divers to pulmonary and dive-related injuries.
- Abstaining from diving following COVID-19 diagnosis is required for all -duration varies with the severity of the disease.
- If any concern for the persistent deficit to cardiac, pulmonary or cognitive function, or exercise tolerance exists, there should be a low threshold to pursue workup as detailed in the table above. (PFT’s, ECG, echocardiogram, exercise stress test, chest imaging, etc.
ResusX:Rewired: Peripheral Pressors by Glorilyn Ong
- Peripheral pressors and tips on obtaining peripheral access
POCUS to Assess for Venous Congestion by Korbin Hayback
- Venous congestion is often not considered but is actually an important factor for organ perfusion and other deleterious clinical conditions.
- With the use of VExUS, venous congestion can be assessed.
- By investigating different vessels with Doppler, we can assess the effects of venous return on the right atrium and ventricle, and also view venous congestion’s effect on more peripheral organs.
- By investigating the different vessels as a whole, we also can take advantage of eliminating the various pitfalls inherent in looking at only one area affected by venous congestion.