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Archives for 2013

Cardiothoracic Surgical Intensive Care

December 3, 2013 by CrashMaster

best book: Manual of Perioperative Medicine by Bojar Post-CABG what was bypassed? discrete lesion vs. diffuse disease what was the graft material? art vs. vein, pedicle vs. free Looking for MAP 70-80 and DBP>50 First 6 hours, need CI>2.0 Hb 8.0 Fix acidosis CVP is actually a good monitor of RV failure Consider SWAN if […]

Filed Under: 03. Intensive Care, cardiology

Bed Bugs

November 30, 2013 by CrashMaster

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Filed Under: 12. Environmental

Transcranial Doppler

November 23, 2013 by CrashMaster

Article on the time-dependent validity of  TCD to assess brain death (J Neurol Neurosurg Psych 2006;77:646)

Filed Under: 08. Ultrasound

Oliguria and Urinary Electrolytes

November 17, 2013 by CrashMaster

Post from Nickson on Life in the Fast Lane USES Oliguria UNa+ low (<10mmol/L) – extravascular volume depletion UNa+ high (>20) – tubular damage Hyponatraemia UNa+ low (<10) – extra-renal losses UNa+ high (>20) – renal salt losing states, SIADH, diuretic therapy Fractional excretion of Na+ = 100 x UNa+ x PCr / PNa+ x […]

Filed Under: 03. Intensive Care, renal

Blakemore Placement

October 3, 2013 by CrashMaster

Blakemore Tube My BP manometer with the adapter from the salem sump test for leaks evacuate air and put in plugs HOB 45 pass it to at least 50 cm numbers on tube should face the right lateral portion of the esophagus on the Bard tube get xray 250-300 cc air in the gastric balloon […]

Filed Under: 02. Procedures

Perioperative Management

September 18, 2013 by CrashMaster

Perioperative beta-blockade is a farce once the made-up trials have disappeared (Heart doi:10.1136/heartjnl-2013-304262)

Filed Under: 09. Medical/Surgical

Lipid Rescue

August 25, 2013 by CrashMaster

Caution with interpreting laboratory results after lipid rescue therapy. Punja M et al. Am J Emerg Med 2013 Aug 8 [From the Excellent Poison Review] No abstract available This short case report from Emory University and the Georgia Poison Center makes the point that administering lipid rescue therapy (LRT) may affect laboratory results in ways that […]

Filed Under: 14. Toxicology

Pulmonary Artery Catheter (PAC, Swan)

June 27, 2013 by CrashMaster

  RudolfI am fan of using of PACs long time ago. I am just try to utilize the cardiac cycle to move it. It looks like a boat floating through the heart. First; i have to think if i really need it and it will affect the patient’s outcome? Are there any alternatives? Second; I […]

Filed Under: critical care procedures

Tracheostomy and Trach Emergencies

April 3, 2013 by CrashMaster

Head-of-Bed Signs and UK Trach Safety Project http://tracheostomy.org.uk//Templates/Algorithms.html When to Trach Consider when > than 14 days of intubation are planned. Risks include: Tracheoinnominate Artery Fistula (TIA)-causes severe airway bleeding which can be fatal.  Consider hyperinflating the cuff to tamponade bleeding as temporizing measure.  In differential of any bleeding >48 hours after placement. Tracheoesophageal Fistula […]

Filed Under: critical care procedures

Airway Carts

March 28, 2013 by CrashMaster

Airway Carts Open endotracheal tubes may be safely left on an ED airway cart for 48 hours. (Am J Emerg Med. 2005 Jul;23(4):548-51.) CONCLUSION: It appears that opening, preparing, and storing ETTs in an ED airway cart for up to 48 hours does not increase the risk of bacterial contamination of the ETTs. Sterility of […]

Filed Under: airway

Exam Preparation

March 27, 2013 by CrashMaster

Bizz-Buzz-and-Killer-Foils

Filed Under: 15. Practice and Philosophy of Emergency Medicine

Pericardiocentesis

March 23, 2013 by CrashMaster

Pericardiocentesis 16-18G sheath for initial entry inject agitated saline to confirm 5-7 fr introducer or pigtail J Cardiovasc Ultrasound 1988;7:193 for description of procedure   From Bret Nelson: In this study, a para-apical approach was deteremined to be the optimal site for paracentesis in 2/3 cases: Tsang TS, et al.: Consecutive 1127 therapeutic echocardiographically guided […]

Filed Under: 02. Procedures

Video Laryngoscopy

March 20, 2013 by CrashMaster

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Filed Under: airway

Plasma Exchange

March 16, 2013 by CrashMaster

Plasmapheresis Plasma Exchange review

Filed Under: hematology

Markdown Syntax from John Gruber’s Site

February 27, 2013 by CrashMaster

Markdown Syntax from Daring Fireball: Markdown Syntax Documentation Inline HTML For any markup that is not covered by Markdown’s syntax, you simply use HTML itself. There’s no need to preface it or delimit it to indicate that you’re switching from Markdown to HTML; you just use the tags. The only restrictions are that block-level HTML […]

Filed Under: 16. Miscellaneous & Appendices

Additional Evidence Against Steroids for Spinal Cord Injury

February 24, 2013 by CrashMaster

From: trauma-list-bounces@trauma.org on behalf of ecthompson [ecthompson@msn.com] Sent: 19 February 2004 12:27 PM To: ‘Trauma & Critical Care mailing list’ Subject: RE: Changing behavior… As a healthcare worker we all must do what we feel is in the best interest of our patients. We can’t deliver a therapy that we know or feel is harmful. […]

Filed Under: 16. Miscellaneous & Appendices

Extracorporeal Removal Techniques in Toxicology

February 16, 2013 by CrashMaster

From (J Intensive Care Med 2012;25(3):139) Characteristics of Xenobiotics That Are Cleared by ECR For all 3 techniques Low volume of distribution (Vd; <1 L/kg), that is, not in tissue Single-compartment kinetics Low endogenous clearance (<4 mL/min per kilogram) For hemodialysis MW <500 Da (little data on high-flux membranes) Water soluble No plasma protein binding […]

Filed Under: 14. Toxicology

Supraglottic and Extraglottic Airways (SGAs and EGAs)

February 14, 2013 by CrashMaster

LMAs CLINICAL SKILLS FOR THE PREHOSPITAL USE OF THE LMA Similar to the first laryngoscopy,41 the first LMA insertion attempt should be optimized. Is the Correct LMA Size Selected? The LMA Classic is available in six sizes. The manufacturer recommends two size selection criteria: weight based (for adults patients: size 3, 30 to 50 kg, […]

Filed Under: airway

Blind Nasotracheal Intubation

February 14, 2013 by CrashMaster

Consider awake BNTI in a predicted difficult airway   start with 32 french trumpet anesthetize through it to get post pharynx   Use the left nostril or if using the right turn tube 180°   Facilitated by neutral head position and ET tube cuff inflation to 15cc.   depth is 26-28 cm at nares   […]

Filed Under: airway

Central Line Placement

February 13, 2013 by CrashMaster

Central Venous Catheters and Central Venous Access Central Lines IJ Lines Go straight through medial portion of lateral head of SCM muscle.  (J. Cardio Vasc Anes 8:6) Femorals Higher Infection Rate, Higher Thrombosis Rate than subclavian (French, Prospective Trial JAMA 286:6, 2001 JB   ) Study of cath related infection shows Subclav<IJ<Femoral (Intensive Care Medicine Volume […]

Filed Under: 02. Procedures

Cricothyrotomy

February 13, 2013 by CrashMaster

Heard’s CICO algorithm (Anaesthesia 2009;64:601) Cricothyrotomy (Surgical) Stand at pt’s right (if you are right hand dominant, otherwise reverse all sides) Left hand holds thyroid cartilage with index finger touching membrane. Make a vertical incision from thyroid cartilage to above jugular notch. Make horizontal stab incision through cricothyroid membrane Drop trach hook into incision with […]

Filed Under: airway

Thromboelastography (TEG) and RoTEM for Trauma

January 30, 2013 by CrashMaster

 

Filed Under: 06. Trauma

ICU Management of Brain Tumor

January 13, 2013 by CrashMaster

acutely bring NA up to 150 until post-op with 3% infusion and 23.4% boluses. After op, continue 3% or 2% to maintain sodium within 10 of plateau, keep weaning slowly over 48 hrs post-op at which point can transition to NS   Steroids Decadron 10 mg continue 8-32 mg/day posterior fossa will need slow wean […]

Filed Under: neurology

Foreign Bodies: Ingested, Aspirated, and Inserted

January 5, 2013 by CrashMaster

(Ann Emerg Med 2016;66(6):570)   Use kidney stone forceps if you need to remove a foreign body with Glidescope (Resuscitation 84 (2013) e3– e4)

Filed Under: airway

Bronchoscopy

January 2, 2013 by CrashMaster

Bronchoscopy simulator online http://www.bronchoscopy.org/ for training and maybe even better http://www.thoracic-anesthesia.com/?page_id=2&langswitch_lang=en   need 2mm larger ET tube than diameter of scope, so 8mm tube to use adult size bronchoscope Anaesthesia 2012, 67, 1042–1056   Procedure from Practical Bronchoscopy Some bronchoscopists prefer to face the sitting or lying patient whilst others stand behind the head of […]

Filed Under: critical care procedures


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