Blog

How-To: Preoxygenation via SIMV Noninvasive Ventilation

Inspired by a morning report discussion from our very own Lara Vanyo on preoxygenation strategies, I thought it would helpful for a brief run-down on the button-pushing needed to perform preoxygenation by way of noninvasive ventilation. The video below is specific to the vents we have at Sinai–Weingart and Elmer have already shown us how toRead more

That Vitamin C in Sepsis Newsflash

A number of really bright people are still unsure of what to make about the vitamin C, steroids and thiamine newsflash that’s taken Twitter by storm yesterday. At Sinai here we’re the curious types, so we chatted with our pharmacist who similarly didn’t know what to make of the headlines given the lack of a randomizedRead more

Giving tPA to a patient on aspirin? What about aspirin and Plavix?

Does it matter if my patient getting tPA is on prestroke antiplatelets?   The neurology and ED teams have decided to give tissue plasminogen activator (tPA). As an outpatient, the patient is on aspirin and clopidogrel dual antiplatelet therapy. Does it matter that they’re on aspirin and Plavix? Does prestroke antiplatelet therapy in acute ischemicRead more

That Prolonged QT Warning?! Magnesium for Cardiac Arrhythmias

You get a pop-up warning in the electronic medical record about potentially adverse interaction with a prolonged QT interval. What’s the risk, right? Afraid of a little torsades de pointes? Can’t we just give some prophylactic magnesium and call it a day? Let’s see if there’s any literature out there… First off, let’s review magnesium.Read more

The 52 in 52 Review: Comparison of Dopamine and Norepinephrine in the Treatment of Shock

The 52 in 52 Review: Comparison of Dopamine and Norepinephrine in the Treatment of Shock   Article Citation: De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779-89.   What We Already Know About the Topic: The recent 2016 Surviving SepsisRead more

Mechanical Ventilation Protocol in the ED

Citation Fuller BM, Ferguson IT, Mohr NM, et al. Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial. Ann Emerg Med. 2017; Clinical Question Does a multifaceted, 4-part, ED-based mechanical ventilator protocol improve respiratory and ventilator-associated outcomes? The Short Version: Using a mechanical ventilation protocol (i.e., protective tidal volumes, appropriate PEEP, lowRead more

Hypertonic Saline or Mannitol for Head Injury?

Traumatic Brain Injury & Neurocritical Care You’ve just intubated your traumatic brain injury patient and the repeat pupil exam shows signs of herniation. In addition to your other interventions (e.g., Reverse Trendelenburg positioning, optimization of sedation/analgesia), do you reach for the hypertonic saline or mannitol as osmotherapy? What risks and benefits come with either therapy?Read more

High Flow Nasal Cannula Better Than Conventional Therapy

High-Flow Nasal Cannula for Avoiding Intubation?   Citation: Ni YN, Luo J, Yu H, et al. Can high-flow nasal cannula reduce the rate of endotracheal intubation in adult patients with acute respiratory failure compared with conventional oxygen therapy and noninvasive positive pressure ventilation? A systematic review and meta-analysis. Chest. 2017   What We Already Know:Read more

The 52 in 52 Review: Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy

Article Citation: Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303(8):739-46.   What We Already Know About the Topic: Lactate physiology can assist in triaging the severity of illness for septic patients. While the underlying pathophysiology canRead more

Don’t Forget The Right Ventricle

The Right Ventricle The right ventricle (RV) has been getting more coverage lately from the Wilcox et al review article in Annals to the continued coverage in many critical care circles where anesthesia and emergency medicine overlap.(1)  Furthermore, the increased presence of VADs and physiology-centric thinking in the resuscitation units of the ED require facilityRead more