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…
Post-intubation Sedation – Tips for the Intubated Patient You’ve just finished intubating your hypotensive, acute respiratory failure patient. Other than the pharmacologic and hemodynamic considerations, what other things should infor…
When we call our colleagues from ENT with a question about a patient’s tracheostomy, they’ll want to know what type of tube the patient has. Let’s go over two types: Plastic Tubes Flexible plastic tubes (most common brand name is Shi…
“Trust, but verify” -Ronald Reagan Why would you need ultrasound for tube confirmation? You can confirm placement with direct visualization (sometimes video laryngoscopy), use end tidal CO2, look for color change on color…
“The role of a clown and a physician are the same – it’s to elevate the possible and to relieve suffering.” -Patch Adams Do you regularly raise the head of the bed when you intubate? Well, maybe you should! A recen…
“There is nothing like the cure of fresh air for cases of bladder infection, paranoia, and Cartesian thinking.” -Rawi Hage Title: “The 52 in 52 Review: Noninvasive ventilation in acute cardiogenic pulmonary edema” Article Cita…
“Ventilation is the profound secret of existence” – Peter Sloterdijk Article Citation: Brochard L, Mancebo J, Wysocki M, Lofaso F, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N En…
A blind digital intubation involves using one’s own fingers to feel the laryngeal inlet and then guide an ETT or bougie into the trachea. Read about it, but never thought I’d see it in the ED. Until recently as an almost last re…
Intubating a patient with a suspected head bleed is one of the highest risk situations we encounter as ED physicians. A failed attempt with enough airway manipulation can potentially increase ICP and have profound negative effects on patien…
You are working resus at 3 am when you hear an alarming vent. It’s the patient in room “E” who is intubated and has been admitted for 36 hours waiting for a stepdown bed. The patient is satting 99% and you are tempted to just hit the sile…
Ventilator management can be very simple or complex. As boarding continues to plague the emergency department, ventilated patients become more commonplace. The emergency physician should be well versed in ventilator settings as well as acti…
A 65 yo M is rushed into the resus room. He is pale and is vomiting a mixture of coffee ground emesis and bright red blood. His vitals are stable currently but he is continuing to vomit in the emergency department. This patient requires a d…
You see a 20 month old with no PMH who has been wheezing and coughing for a few days. His cousin has RAD. Should you just give him a little albuterol and see how he does? Here’s his x-ray: What are you concerned for?
You’re peacefully writing a note when you notice an incessant beeping from the back of your resus bay. It’s not a monitor, it’s a ventilator. What do you do? Press the silence button? Call respiratory therapy? As Dr. Weingart has said, v…
Asking an anesthesiologist or EM doc their choice of paralytic can spark heated debate. What do you prefer? Succinylcholine: -depolarizing agent -30-60 sec onset -8-15 min duration -adverse reactions: bradycardia, hyperK, fasciculations, m…
