tl;dr (<5 minutes) Quantitative end tidal: Partial pressure of CO2 in the gas sample at the end of expiration. You get a numeric value and a wave-form. EtCO2 is typically lower than PaCO2 due to anatomical and pathological dead space. No…
In addition to his love of ketamine and proper PSA technique, Reuben Strayer has written and talked extensively about ED intubations. Here is his checklist so that you can minimize complications and maximize your success: For more informati…
Courtesy of our Resus nurse extraordinaire Molly Sullivan! Here are some of the specifics about setting up an A-line at Sinai:
You’re on a lovely amble through the backcountry when suddenly you see smoke rising nearby and catch a whiff of a familiar scent that throws you back to your med school OR days: burning flesh. You quickly find one obtunded, severely burned…
You’re working in the Cardiac Room as a new PGY-2 and the triage nurse calls you to evaluate a patient. He’s about 40 years old, slightly overweight, known to the ED for chronic alcohol abuse, and appears to be intoxicated yet again.The nur…
Bottom line up front: A recent large, high quality meta-analysis reported a significant mortality effect with the use of liberal, rather than conservative, oxygen supplementation. The number needed harm for 30-day mortality was 1 in 126. A…
Bottom line up front: (1) Intubating those with TBI or spontaneous ICH is dangerous. You want to prevent increased ICP that is caused by laryngoscopy. (2) Pre-treat with fentanyl if time and the pt’s BP allow. The dose of fentanyl is larger…
Clinical Question – What is the best way to intubate and provide post-intubation care for the critically ill asthmatic? Case: 54M mhx asthma (hx of 2 intubations, last 2 months ago) presents to the cardiac room in respiratory distress…
Clinical Question – Why use High Flow Nasal Cannula? When should you use it over BIPAP? HFNC offers several advantages compared to conventional oxygen therapy, including: Ability to deliver O2 at up to 60 LPMs at nearly 100% FiO2. Thi…
Desaturation leading to hypoxemia during RSI is a familiar picture and apneic oxygenation was developed to prevent occurrence of oxygen desaturation during apneic period. Does the latest evidence support this practice? ENDAO trial publishe…
We all love FOAM, and we all love airway. Today’s pearl will introduce you to a corner of FOAM you may not have come across, as well as a corner of airway management you might not know about. I’m a big fan of Jed Wolpaw’s…
There you were, minding your own business when EMS brings you a sick-as-can-be patient, intubated in the field for who knows what. Someone gets overzealous with their trauma shears and cuts off the pilot balloon on the endotracheal tube. Th…
Compiled from a variety of sources from #FOAMed (specifically, NYSORA and the ACCRAC podcast) and inspired by morning report today with Taryn and Tina, here is a quick and dirty rundown for awake intubation. Firstly, we should be considerin…
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…
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-ba…
