Contributor: Aaron Lessen MD Educational Pearls: Why is airway management more difficult in obesity? Larger body habitus causes the chest to be above the head when the patient is lying supine, creating difficult angles for intubation. Reduced Functional Residual Capacity (FRC) causes these patients to deoxygenate much more quickly, reducing the amount of time during…
Read MoreContributor: Jason Papazian MD, Travis Barlock MD, Jeffrey Olson Summary: In this episode, Dr. Travis Barlock and Jeffrey Olson meet in the studio to discuss several clips from Dr. Jason Papazian’s talk at the event “Laboring Under Pressure, Managing Obstetric Emergencies in a Global Setting” from May 2023. This event was hosted at the University…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: What is thrombolysis? Thrombolysis is performed by administration of a medication that promotes the body’s natural ability to break up clots. These medications include Alteplase (tPA) and Tenecteplase (TNK). The main side effect of using such an agent is bleeding which typically occurs at puncture sites but can also…
Read MoreContributor: Meghan Hurley, MD Educational Pearls: Two main reasons to choose non-traditional RSI Anatomically challenging airway Physiologically difficult patients: hypoxia, metabolic acidosis, hemodynamic instability Ketamine may help patients remain hemodynamically stable In critical patients, it is important to consider non-traditional RSI medications to improve outcomes References 1. Lyon RM, Perkins ZB, Chatterjee D, Lockey DJ,…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: The management of severe asthma or COPD exacerbation is complex, especially when the patient requires intubation/ventilation Asthma is an obstructive airway disease that can cause air trapping and hyperinflation of the lungs To avoid worsening hyperinflation patients typically require slower respiratory rates, lower tidal volumes, and increased expiratory time…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Tracheostomy bleeding is a rare but potentially life-threatening complication that usually occurs within the first month of tracheostomy tube placement No matter how severe the bleeding, every patient should be evaluated to rule out a tracheo-innominate fistula between the tracheostomy and the innominate artery If the patient is currently…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Tidal volume is the amount of breath a patient receives in a single ventilation Traditional tidal volume (TV) setting was 10 ml/kg but studies showed lower TV had less incidence of respiratory distress, ARDS, and overall better outcomes ED ventilation settings may get carried on for hours or days…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Recent study looking at a pediatric emergency department to determine what percentage of patients after intubation received sedation within 10 minutes after intubation About 25% of the patients in the study received sedation within 10 minutes after intubation Only 75% of the patients in the study received sedation in…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: An endotracheal tube introducer or bougie are often used as a rescue device during difficult intubations as they are small and can be placed blindly Large randomized-controlled trial looked at first-pass bougie use versus standard intubation to determine if there was improvement in first-pass success rate No difference in…
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Ludwig’s Angina Chief Complaint: Neck and jaw pain HPI: 32-year-old female with a history of IV drug use, last injected methamphetamine 2 days ago, presents for 1 day of right-sided neck and jaw pain with associated swelling. She denies trauma, dental pain and sore throat. She states the pain started around lunchtime yesterday and that…
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