This is a great paper recently presented at the Critical Care Transport Medicine Scientific Forum. It covers a subject area I have always been interested in. Over time, our understanding of critical care has evolved to show the importance of a low tidal volume strategy for ventilating patients, particularly those with lung injury/ARDS. However, even patients with normal lungs are potentially harmed by high tidal volume strategies.
Read MoreThis week we learned about all the hardware that can go into our patient's CNS and how it can go wrong. We also heard about complications of Varicella infection, set out to optimize visualization of a needle on US, learned to give better feedback to the difficult learner, heard about ED super-utilizers and strategized about ventilator management.
Read MoreThis week we had our annual Critical Care Symposium where we invited our own critical care trained faculty and a special guest to have a day chock full of critical care goodness.
Dr. David Norton, Assistant Professor of Medicine and Director of the UCMC Medical Intensive Care Unit
Definition of Refractory Shock:
No clear definition exists, but we are generally describing a state of decreased vascular responsiveness despite high vasopressor infusion.
Read MoreYou have inherited a patient in the VA MICU at signout. The patient presented with spontaneous bacterial peritonitis and altered mental status and was intubated for airway protection and hypoxic/hypercarbic respiratory failure. The patient’s altered mental status has resolved but the patient remains intubated waiting for a second large-volume paracentesis that can’t be done over the long weekend at the VA. The RT calls you asking for a one time dose of 5mg Versed, but on a quick glance at the chart, the patient has been getting these Q2 hours for the last several days. You go to the bedside and find an agitated patient motioning to take out the tube. “He’s bucking the vent doc!”
Vent settings: AC-VC: TV500 RR12 PEEP8 FiO2 30%
Read MoreThe term Acute Lung Injury (ALI) is being phased out and instead Acute Respiratory Distress Syndrome (ARDS) is now graded mild, moderate, and severe depending on the PaO2:FiO2 ratio
The median onset of ARDS after presentation to the ED was 2 day but could be anywhere from 5 hours to 5 days
ARDS Net was a foundational trial in ventilator management and was a triall of tidal volume and plateau pressures. The primary end point, mortality, was reduced by >20% when folks were on a low TV (6cc/kg) and lower PP (25-30 mm Hg).
Read MoreNext to STEMI and neurologic emergencies such as spontaneous ICH, SAH, and ischemic stroke, one of the most common pathologies we transfer from one facility to another on Air Care is sepsis. However, unlike many of the other patients we transfer, these patient’s are usually being transferred from the ICU of an outlying facility to the ICU of a tertiary referral center that can deliver a higher intensity of care. I sat down and discussed with Dr. Bill Knight, a former flight MD and now Emergency Medicine and Neurocritical care physician, about some of the complexities of caring for these patients.
Read MoreSRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
