Critical Care Archives - Page 2 of 9 - The Emergency Medical Minute

Critical Care

Podcast # 484: Elevated ICP

Contributor: Charleen Gnisci, PharmD Educational Pearls: Causes of increased intracranial pressure may include intracranial hemorrhage, malignancy, and trauma.  While definite treatment is to remove the offending cause, there are emergency medicine   Non-pharmacologic methods include elevating head of bed and removing noxious stimuli Pharmacologic options include mannitol and hypertonic saline Hypertonic saline is best delivered through…

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Podcast # 461: Breath Stacking

Author: Gretchen Hinson, MD Educational Pearls: Breath stacking occurs when a patient is unable to expire fully before another inspiration In intubated/ventilated patients, this is because adequate time has not passed before exhalation Asthmatics are susceptible due to the prolonged expiratory phase Complications can include reduction in cardiac preload and cardiovascular collapse Pursed-lip breathing can…

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Podcast # 457: Stroke Scores

Author: Jared Scott, MD Educational Pearls:   Modified Rankin Score:  measure of disability often used to qualify outcomes following stroke  = no disability, 6=dead, 0-1 indicate good outcome) 0-6 Scale 0-1 indicative of good outcome ASPECT score: uses CT to quantify the extent of changes in the brain due to ischemia 0-10 Scale 10 areas…

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Podcast # 456 Hypoglycemia: Not feeling so sweet

Author: Jared Scott, MD Educational Pearls:   Beta-blockers can mask the effects of hypoglycemia Prolonged/refractory hypoglycemia should raise a suspicion for sulfonylurea (or other oral hypoglycemic) overdose Interventions to reverse hypoglycemia include feeding the patient, IV dextrose, glucagon Octreotide can be used as an antidote with sulfonylurea ingestion References Alsahli M, Gerich JE. Hypoglycemia. Endocrinol…

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Podcast # 454: Tylenol Overdose

Educational Pearls:   Acetaminophen overdose can also present in patients taking too much over the course of days to weeks – not just intentional ingestions If acute overdose is suspected, refer to the Rumak-Matthew nomogram to guide treatment based on time of ingestion and the time of level In chronic overdose, Tylenol levels will not…

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Podcast # 372: The Latest on Epinephrine in Cardiac Arrest

Author:  Don Stader, MD Educational Pearls: 8014 patients with out-of-hospital cardiac arrest randomized to epinephrine vs placebo 30-day survival was not dramatically better between groups (3.2%in the epinephrine group and 2.4% in the placebo group) Functional neurological outcome was nearly identical at 2.2% and 1.9% of patients Adds to literature that epinephrine provides little important…

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Podcast # 370:  Rapid Fire Neonatal Resuscitation

Author:  Erik Verzemnieks, MD Educational Pearls: In the panic of a precipitous ED delivery, remember: Warm. Dry. Stim.  It will solve most of your problems in most scenarios Start compressions if heart rate is less than 60 Put the pulse ox on the right hand – it may make a difference as it is preductal…

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Podcast # 350: Pressors and Ischemia

Author: Nick Hatch, MD. Educational Pearls: A common concern using vasopressors is the risk of digital and mesenteric ischemia. The absolute risk of digital ischemia and/or mesenteric ischemia is pretty low. Norepinephrine at its highest doses carries a 5% digital ischemia rate and a 2% mesenteric ischemia rate. The studies demonstrating this complication were predominately…

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Podcast # 340: Drowning

Author: Chris Holmes, MD Educational Pearls: Epidemiology: 80% male, ages 1-4 at greatest risk, African-American > Caucasian. Freshwater and ocean water may have more bacteria than pool water. Salt water is hyperosmolar, which theoretically increases risk of pulmonary edema. Greatest physiologic insult is from hypoxia secondary to fluid aspiration or laryngeal spasm. Patient survival is…

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Podcast #334: Resuscitative Thoracotomy

Author: Dylan Luyten, MD Educational Pearls: Resuscitative thoracotomies are most commonly used for treatment of cardiac tamponade and to selectively perfuse the brain and heart in setting of hemorrhage control. Resuscitative thoracotomies are indicated in patients with penetrating injuries who lose vitals in the ED or those who had vitals within the last 10 minutes….

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