Critical Care Archives - The Emergency Medical Minute

Critical Care

Podcast 853: Critical Care Medications – Vasopressors

Contributor: Travis Barlock MD Educational Pearls: Three categories of pressors: inopressors, pure vasoconstrictors, and inodilators Inopressors: Epinephrine – nonselective beta- and alpha-adrenergic agonism, leading to increased cardiac contractility, chronotropy (increased heart rate), and peripheral vasoconstriction. Dose 0.1mcg/kg/min. Levophed (norepinephrine) – more vasoconstriction peripherally than inotropy; useful in most cases of shock. Dose 0.1mcg/kg/min. Peripheral vasoconstrictors:…

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Podcast 830: Peripheral IV Flow Rates

Contributor: Travis Barlock, MD Educational Pearls: Gauge and length of catheter are determinants of flow rate  Smaller gauges produce higher flow rate Longer catheters reduce flow rate   Common IV gauges produce predictable rates of flow:  20 gauge = 60 cc/min 18 gauge = 105 cc/min 16 gauge = 220 cc/min  Central lines typically have two…

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Podcast 771: Intubation in Cardiac Arrest

Contributor: Don Stader, MD Educational Pearls: In a secondary analysis of the PART trial, the mortality effect of timing of airway management for patients in cardiac arrest was examined Study looked at whether timing played a part in both laryngeal tube placement or endotracheal intubation during cardiac arrest Did not find any association of timing…

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Podcast 754: Balanced Fluids vs. Normal Saline, The Battle Continues

Contributor: Aaron Lessen, MD Educational Pearls: Normal saline is thought to interfere with renal function and cause an acidosis and balanced fluids (like lactated ringers) are a better option The SALT-ED trial and SMART trial showed a small benefit with renal injury and need for dialysis using balanced fluid in critically ill patients Recent multicenter…

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Podcast 689: Peri-Intubation Hypotension

Contributor: Ricky Dhaliwal, MD Educational Pearls: Hypotension in patients requiring intubation should be resuscitated as much as possible While intubating, the negative inspiratory pressure goes away decreasing cardiac preload and worsening hypotension Phenylephrine can be given via push doses to  increase blood pressure from  alpha agonism For sedation, avoid propofol with hypotension and opt for…

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Podcast 679: ECMO for Refractory VFib

Contributor:  Aaron Lessen, MD Educational Pearls: Refractory ventricular fibrillation, defined as 3 defibrillation shocks without resolution, was studied via RCT looking to compare ECMO with cardiac cath vs. typical resuscitation After 30 patients (15 each arm), the trial was stopped because such a significant benefit seen in the ECMO arm 6 patients survived and 3…

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Podcast 672: Oxygen Things

Contributor: Aaron Lessen , MD Educational Pearls: Patients on 10L or more of oxygen per minute in the ICU were randomized to oxygen goals of 90% or 96% to compare 90-day mortality rates Mortality rates were about 42% for both of oxygen target groups, indicating no significant difference References Schjørring OL, Klitgaard TL, Perner A,…

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Podcast 606: The Oxygen Wars

Contributor: Aaron Lessen, MD Educational Pearls: The use of oxygen is controversial when treating patients with certain conditions, like MI’s, stokes, or ARDS because adverse outcomes have been demonstrated with using high oxygen concentrations. The Oxygen ICU trial looked at using higher and lower oxygen levels in treating intubated ARDS patients and found that mortality…

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Podcast 595: Peripheral Vasopressors

Contributor: Aaron Lessen, MD Educational Pearls: Traditional teaching has shied away from using vasopressors through peripheral IVs Tissue necrosis from extravasation is cited as a risk of use of vasopressors through a peripheral site However, risk of extravasation is low (2-4%) and even more rarely results in significant complications Using an  IV that is more…

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Podcast 568: Shock ‘em! 

Contributor: John Winkler, MD Educational Pearls: Unstable ventricular tachycardia (VT) typically manifests with syncope, shortness of breath, diaphoresis and/or chest pain with hemodynamic instability Electrical cardioversion of unstable ventricular tachycardia is first line treatment Starting with a higher energy level (or just using the maximum) when performing cardioversion may set you up for better success…

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