Week in Review: 9/27/20

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Shyam Murali
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:

More than Hot Air, End-Tidal CO2 by Steve Haywood

  • For normal exhalations, you should see a good plateau on your waveform
  • Each plateau should appear similar with small EtCO2 changes between breaths
  • If you have multiple, short, peaks with wildly varying EtCO2 numbers, your patient is like taking shallow breaths and you are not actually measuring gas from the alveoli which contains the most CO2

REBOA for What Now??? by Zaf Qasim

  • Can REBOA be used for nontraumatic cardiac arrest?
  • Dr. Qasim covers a new article about this!

ResusX19: Pearls from Day 1 by Shyam Murali

  • Catch up on day 1 lectures from ResusX19 as we get closer to #ResusX20!

Secrets of the Right Ventricle by Haney Mallemat

  • Respect the right ventricle!
  • Be on the lookout for the RV death spiral where RV dysfunction leads to decreased cardiac output and MAP; this in turn causes significant issues for the entire heart.

The Vitals: Pulsus Paradoxus by Obiajulu Anozie

  • 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

Buprenorphine: The Micro and (not so) Micro Factoids by Rachel Rafeq

  • Buprenorphine can be an effective method of helping your patient overcome opioid use disorder
  • Familiarize yourself with the traditional method (best for the ED setting) and the micro-dosing method (best for the ICU setting)
  • Buprenorphine has added pharmacologic and safety benefits compared to other therapies making it an ideal
    choice

When A VAD Goes BAD! by Kami Hu

  • Call the patient’s VAD coordinator immediately.
  • Assess the patient’s global perfusion & MAP.
  • Ensure the LVAD is powered and working.
  • Use echo to determine the potential cause of poor perfusion states.

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