Category: Resuscitation (page 1 of 2)

Airway (Part 4)

Plan B. What to do when you CAN’T intubate a patient. 

Airway (Part 3)

How to intubate a patient… 

Airway (Part 2)

This week we continue our discussion (started several years ago) on the most important procedural skill set in Emergency Medicine…. Airway!

Stopping CPR

When should you stop CPR and pronounce death? 

Jordan MR, O’keefe MF, Weiss D, Cubberley CW, Maclean CD, Wolfson DL. Implementation of the universal BLS termination of resuscitation rule in a rural EMS system. Resuscitation. 2017;118:75-81.

Jabre P, Bougouin W, Dumas F, et al. Early Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ Donation. Ann Intern Med. 2016;165(11):770-778.

Goto Y, Funada A, Goto Y. Duration of Prehospital Cardiopulmonary Resuscitation and Favorable Neurological Outcomes for Pediatric Out-of-Hospital Cardiac Arrests: A Nationwide, Population-Based Cohort Study. Circulation. 2016;134(25):2046-2059.

Vents

Vents are easy!!!! Today we will discuss the basic approach to using a ventilator machine.

Cardiac Arrest (ACLS)

You will probably witness a few cardiac arrest cases during your clerkship. Sometimes these happen in the hospital, but usually these patient’s will be brought into the ED, CPR in progress, by EMS. Just like in trauma, we follow a very basic, logical algorithm when we resuscitate these patients, and this algorithm is called ACLS.

The First 5 Minutes

This week we will discuss some Emergency Medicine 101. This is my personal approach to the initial management of crashing patients. Not only does this algorithm work well in real life, it also works well in sim, and during verbal cases with my attendings. Listen to the old ABC episodes if you want to go more in depth.

Hypoxia

Lets talk about oxygen. Hypoxia is bad, and we need to know how to help these patients. However, giving TOO much oxygen is also bad. In this episode we will review the basics of oxygen administration as well as review the current literature so you can impress your attendings when they try to pimp you.

Circulation (Shock)

Today is episode C, the final episode in our 3 part podcast series on the approach to a crashing patient. In previous episodes we covered AIRWAY: how the first thing we need to do is suction and move the posterior portion of the patient’s tongue. We covered BREATHING: how we need to fix hypoxia by increasing FiO2 and adding PEEP. And today we are covering CIRCULATION.

With circulation, it all comes down to tank, clogged pipes, broken pipes, and pump. Which is a fancy way of saying… We fix all of the different types of SHOCK. So pay close attention, because the treatment of shock is a hugely important topic in Emergency Medicine. It is a topic that you need to master if you want to pass your shelf and do well on your SLOE.

Breathing

Today is episode B in a series about our approach to the crashing patient. As we discussed in the previous episode, at some point during your clerkship, you will have a patient that starts dying right in front of your eyes. And it will be very scary! In Emergency Medicine, we fall back onto the “A-B-Cs” whenever this happens. We fall back onto an algorithm that lets us take control of virtually any situation in less than 60 seconds.

In this episode, we cover B-Breathing. In medical school, we learned that breathing equals both oxygenation and ventilation. However, between the two of these, oxygenation is BY FAR the most important in the acute setting. Hypoxia kills patients immediately, so you need to fix hypoxia immediately. As we will discuss in this episode, there are only two ways to do this. You either add FiO2, or you add PEEP.

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