Contributor: Aaron Lessen,MD Educational Pearls: Recent study looked at mechanically ventilated patients in ED and ICU to determine if O2 saturation level impacted patient outcomes 2541 patients randomized to one of three target O2 saturation levels Low: 90% (Range: 88-92%) Intermediate: 94% (Range: 92-96%) High: 98% (Range: 96-100%) Outcome indicators Primary: Number of days alive…
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: Travis Barlock, MD Educational Pearls: Most oxygen in the body is bound to hemoglobin, forming oxyhemoglobin. Less than 1% of the oxygen in the body is dissolved in plasma. Pulse Oximeters (Pulse Ox) function by emitting wavelengths of light from one side, and capturing the amount absorbed on the opposite side. A calculation determined…
Read MoreContributor: Dylan Luyten, MD Educational Pearls: Positive End Expiratory Pressure (PEEP) is positive pressure within the lungs and maintained throughout the entire respiratory cycle. It is the pressure preventing alveoli from collapsing at the end of exhalation. When using a bag valve mask (BVM) to ventilate patients, always attach the PEEP valve to prevent intrathoracic…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: End tidal CO2 is accurate to 1-4 mmHg in intubated patient but use with those on positive pressure ventilation like BiPAP is unclear Study looked at patients on BiPAP for COPD or CHF and found end tidal CO2 measurements were significantly underestimated when compared to VBG levels End tidal…
Read MoreContributor: Alec Coston, MD Educational Pearls: Flash pulmonary edema or Sympathetic Crash Acute Pulmonary Edema (SCAPE) is a severe illness that requires aggressive treatment Often in patients with heart failure and a sympathetic surge increasing heart rate, decreased diastolic filling, increased preload, and increased afterload causing pulmonary edema Clinical diagnosis: acute onset diaphoresis and respiratory…
Read MoreContributor: Nick Hatch, MD Educational Pearls: High flow nasal cannula (HFNC) or “heated high flow” can deliver higher oxygen levels than nasal cannula It typically is used as an “intermediate” between oxygen via nasal cannula and other non-invasive positive pressure devices, such as BiPAP Can modify both the FiO2 and flow rate Maximum flow rate…
Read MoreContributor: Adam Barkin, MD Educational Pearls: Multi-center open-label non-inferiority trial looked at treatment of pneumothorax with a small-bore chest tube versus conservative management with exceptional follow up 316 patients ages 14-50 with moderate to large pneumothorax (>32% measured on CXR) were randomized into one of the two treatment arms 15% of the conservative group required…
Read MoreContributor: Thomas Seibert, MD Educational Pearls: High Altitude Pulmonary Edema (HAPE) typically occurs 2-4 days after arriving at elevation Symptoms include: Fatigue Dyspnea Cough Treatment includes: Descent to lower elevation Oxygen supplementation Nifedipine Caused by sympathetic stimulation from hypobaric hypoxic exposure, causing uneven pulmonary vasculature constriction and when paired with a leaky endothelium, pulmonary edema….
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Contrary to many assumptions, meter-dose inhalers (MDIs) are as effective as nebulizers in pediatric and adult patients Nebulizers are associated with higher rates of tremor, tachycardia; they cost more and are associated with longer ED stays Though it may take some convincing, in a patient that is physically able,…
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