Week in Review: 9/6/20

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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:

Do Not Intubate During Cardiac Arrest by Steve Haywood

  • If you are the team leader during a cardiac arrest, intubation should be low on your priority list.
  • Intubation during a cardiac arrest has been shown to INCREASE mortality in both pre-hospital and in-hospital settings.
  • As a team leader, if you go to the head of the bed to intubate the patient you lose focus on other important aspects of CPR such as good quality compressions, early defibrillation, and finding reversible causes of PEA.

Under Pressure: Abdominal Compartment Syndrome by Mohamed Hagahmed

  • Early detection and prompt intervention are vital in preventing complications
  • Diagnosis is confirmed by measuring bladder pressure
  • Involve your surgical colleagues early when the suspicion is high so that patients can undergo emergent laparotomy
  • Check out the post for more pearls!

Why ECGs in LVAD Patients are not Worthless by Andrew Phillips

  • ECGs in the presence of an LVAD have electrical interference but still provide valuable data including rate and dangerous rhythms.
  • Atrial fibrillation, ventricular tachycardia, and ventricular fibrillation are important arrhythmias that can be observed in ECGs in the presence of an LVAD.

CATscan DOGmalysis: Part 2 by Rupal Jain

  • “Iodine allergies” don’t exist. Iodine is not the antigenic component. Most reactions to contrast are non-IgE mediated hypersensitivity reactions.

  • The risk of contrast-induced acute kidney injury (AKI) is overstated. Patients who are considered high risk include those with recent AKI and those with eGFR <30. In these patients, give IV fluids.

  • In addition to IV contrast, PO contrast should be considered in CT scans of patients with suspected complication of IBD (i.e. fistula) and post bowel-reconstructive surgery (i.e. anastomotic leak).

Dysautonomia by Obiajulu Anozie

  • Dysautonomia is a complicated disorder that can have serious implications on inpatient mortality in the critical care setting

  • This disorder of the autonomic nervous system requires a careful, patient-centered, and multi-modal approach to effectively manage this condition and prevent further morbidity and mortality

Show Me The Tip! by Shyam Murali

  • For your ultrasound-guided needle-based procedures (central lines, nerve blocks, etc), make sure you can see your needle tip on the ultrasound screen during the entire procedure.
  • Use this technique to prevent complications such as arterial sticks, pneumothoraces, and damage to other surrounding structures.

A Case of Severe Hypernatremia by Eduardo Argaiz

  • Hypernatremia should be treated aggressively to provide patient comfort (thirst)
  • Water replacement should include free water deficit + ongoing water losses
  • Secretory diarrhea is isotonic and does not cause hypernatremia; Only osmotic diarrhea will
  • Increased urea excretion in the setting of recovery from kidney failure is a common cause of free water losses
  • Ongoing urine losses of water can be calculated with the formula for electrolyte-free water clearance

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