Archive for category Critical Care
The Management of the Intra-Arrest
Posted by Scott D. Weingart, MD FACEP in Critical Care on September 5th, 2010
This week we talk about managing the intra-arrest period of cardiac arrest. My paradigm has changed dramatically over the past few years. In the past, I viewed the arrest as a period to teach my residents how to place a subclavian central line, how to intubate when the patient is moving, and how to cram as many drugs as possible into a patient in a short period of time.
Looking at how I manage an arrest today, so much has changed. LMAs instead of tubes, IOs instead of central lines, and so much more.
Trauma Resuscitation with Dr. Richard Dutton
Posted by Scott D. Weingart, MD FACEP in Critical Care on August 15th, 2010
This week on the EMCrit Podcast, we discuss the resuscitation of the hemorrhagic shock patient with Dr. Richard Dutton, MD. Rick was director of trauma anesthesia at the Shock Trauma Center when I trained there. He is an incredible teacher, clinician, and researcher.
Here are the take home points:
- Induction agent choice does not matter in these patients; what matters is DOSE! Reduce dose to 1/10 of full intubating dose.
- Blood products need to be available in the trauma bay for when these patients arrive. If you need to give crystalloid while awaiting the products, give only small amounts just to keep the patients heart beating.
- A systolic of 80 with good perfusion and normal sized vessels is very different than that same SBP in a patient who is clamped down. The former is a resuscitated state, the latter =spiral of death.
- The resuscitation fluid for trauma is equal parts PRBC and FFP.
[Click Here to Read More and Listen to the Podcast]
photo from trauma.org
Procedural Sedation in the ED, Part II
Posted by Scott D. Weingart, MD FACEP in Critical Care on August 1st, 2010
It seems the government and other specialties are trying hard to make sedation as difficult as possible in the ED. We must persevere to provide the best procedural sedation for the maximal comfort and safety for our patients. This continues the discussion started in Part I, where we discussed etomidate, ketamine, and versed/fentanyl. In this podcast, I discuss propofol, ketofol, and dexmedetomidine.
Procedural Sedation in the ED, Part I
Posted by Scott D. Weingart, MD FACEP in Critical Care on July 26th, 2010
It seems the government and other specialties are trying hard to make sedation as difficult as possible in the ED.
We must persevere to provide the best procedural sedation for the maximal comfort and safety for our patients. This brief lecture was originally posted on the defunct EMCrit Lecture Site on 8/7/2009.
I’m reposting it here so that I can post part II sometime this week.
This episode, Part I, covers general concepts on sedation as well as ketamine and etomidate/fentanyl.
Severe CNS Infections
Posted by Scott D. Weingart, MD FACEP in Critical Care on July 13th, 2010
Severe CNS Infections are time dependent diagnoses! You must have a high index of suspicion, a good plan for your work-up, and rapid provision of treatment. After seeing a severely ill meningitis patient, I figured I would do a podcast on some tips and pearls on this topic.
Calcium Channel Blocker Overdose
Posted by Scott D. Weingart, MD FACEP in Critical Care on June 29th, 2010
Calcium Channel Blocker Overdose is one of the worst ODs you may see in the ED. There are new therapies that can counter the effects of these meds, but you need to know how and when to use them.
This week, I am joined by Leon Gussow, MD of the excellent blog: The Poison Review (TPR). TPR is my source for new toxicology articles; I highly recommend it as an incredible read. In this EMCrit Podcast, Leon and I discuss the severe CCB OD.
Top Ten Tips on Therapeutic Hypothermia
Posted by Scott D. Weingart, MD FACEP in Critical Care on June 15th, 2010
At this stage of the game, if your hospital is not offering hypothermia to out-of-hospital cardiac arrests, you are probably lagging behind optimal care. For shockable rhythms, you essentially double your patient’s chances of leaving the hospital with good neurological outcome. However hypothermia can be tough, unless you have done a bunch. Learn from my mistakes in this lecture.
Dominating the Ventilator: Part II
Posted by Scott D. Weingart, MD FACEP in Critical Care on June 1st, 2010
When I was a resident, every vent lecture either put me to sleep or left me dazed and bewildered. I gave a lecture of that ilk when I started working after fellowship. I had become part of the problem. I decided there must be a way to make vent management more understandable and if not interesting, at least bearable.
In this second part, I discuss the strategy of managing the patient with obstructive lungs.
Dominating the Ventilator: Part I
Posted by Scott D. Weingart, MD FACEP in Critical Care on May 24th, 2010
When I was a resident, every vent lecture either put me to sleep or left me dazed and bewildered. I gave a lecture of that ilk when I started working after fellowship. I had become part of the problem. I decided there must be a way to make vent management more understandable and if not interesting, at least bearable.
In this first part, I discuss the strategy of managing the patient with lung injury (everybody except those with obstruction).
There are only 4 things you need to remember for a lung injury patient:
Vt (Tidal Volume) = Lung Protection
Flow Rate = Patient Comfort
Resp Rate = Ventilation
FiO2/PEEP = Oxygenation
A Simple, Powerful Pain Protocol
Posted by Scott D. Weingart, MD FACEP in Critical Care, Pain Management on May 11th, 2010
Even when we can’t cure a patient, we can relieve suffering. On average, we kind of stink at pain control in the ED. One physician, Dr. Ed Gentile, has created a simple path to optimal acute pain control in the ED. I heard this lecture on the EM:RAP podcast and got permission from Drs. Gentile and Herbert to repost it here. This is not a critical care topic per se, but it is applicable to the critically ill, the non-critically ill–-basically any patient who is in pain in the ED.
[Click here to read more and hear the podcast]
