this podcast is really brief--I gave a lecture at Jacobi last week (thanks for having me Jacobites!), and in response to a question I gave this rant on my vision of sedation after intubation.
Note: Please listen to the PDP update episode either before or immediately after listening to this one
Finally a non-intubation topic!
Bolus dose pressors and inotropes have been used by the anesthesiologists for decades, but they have not penetrated into standard emergency medicine practice. I don’t know why. They are the perfect solution to short-lived hypotension, e.g. post-intubation or during sedation.
They also can act as a bridge to drip pressors while they are being mixed or while a central l...
We've had a few gruesome airways in patients with GI bleeds and bellies full of coffee ground emesis.
This is a top 10 list encompassing my approach to this difficult situation:
1. Empty the Stomach
Place a salem sump and suck out all of the stomach contents.
Varices are not a contraindication (see: Digest Dis 1973;18(12):1032, Gastrointest Endosc. 2004 Feb;59(2):172-8, and Anesth Analg 1988;67:283)
Administer Metoclopramide 10 mg IVSS
2. Intubate the Patient with HOB at 45°
This lecture is part of the Laryngoscope as a Murder Weapon Series:
Sorry about the voice--blame the swine flu.
Thanks to Joe Chiang
Severe DKA; Obtunded with pH 6.65, PaCO2 18, Bicarb 5
Pt’s mental status is worsening
The decision is made to intubate
Should you give NaBicarb?
Probably won’t help as patient is already breathing at their maximum. Unless they blow off the Bicarb-generated CO2, they won’t increase their pH signif...
I did a spot on ETCO2 for Amal Mattu's podcast a couple of weeks ago. I try to clear up some of the myths on the use of ETCO2.
Of course the most pervasive and potentially dangerous myth is that ETCO2=PaCO2.
Long story short, in our patients, it doesn't.
Listen to the podcast for more......
Here it is, the 1st EMCrit podcast.
It's on the topic of Sympathetic Crashing Acute Pulmonary Edema (SCAPE). This condition is on a very different part of the disease spectrum from FOPE (Fluid-Overload Pulmonary Edema, an acronum I first saw used by by @Cameronks)
To boil it down to 10 seconds:
Start patient on Non-invasive ventilation with a PEEP of 6-8; quickly titrate to a PEEP of 10-12.
Start the patient on a nitroglycerin drip. Administer a loading dose of 4oo mcg/min for 2 minutes (120 m...