Tuesday, October 19, 2010
Hey, remember that patient you saw?
It's one of the most panic-triggering phase during our day-to-day work...
Reference: http://thecentralline.org/?p=568
Reference: http://thecentralline.org/?p=568
Sunday, October 10, 2010
Rules
- First of all, "Anything can go wrong WILL go wrong, at the WORST POSSIBLE TIME."
- Always recheck marking of ET tube for desaturating patients
- Rising pCO2 in spontaneously breathing patients/pt on PSV => decrease sedation first
- USG is your best friend for procedures (e.g. lines, pleural tap...)
- Remember bougie for endotracheal intubations, check mouth opening and ROM of neck beforehand, position well beforehand, insert the tube deep enough, always check breath sound yourself after intubation, protect patient's teeth during DL
- Stick higher for IJ lines at level of thyroid cartilages to avoid pneumothorax, manipulate to increase diameter of IJ vein (head down, limited head turning/extension, light palpation of carotid pulse)
- Do not blindly correct INR, platelet. Think before given pack cell/FFP/platelet concentrate
- Always check ionized Ca2+ level for post-TOTAL thyroidectomy patient
- O2 flow rate of NRM should > 6L/min
- No need to stop NG feeding just because of coffee ground aspirate
- Always check the patient's position while reading a CXR
- Offer comfort care (e.g. morphine infusion) earlier if indicated
- Use sulperazone as emprical abx for nosocomial infections in "The Unit"
- Know when to wait and when to start antibiotics
- Bronchospasm..."treat medically"...remember "second-line agents" e.g. MgSo4, IV salbutamol, adrenaline infusion, ketamine infusion...
- Remember Difficult Airway Algorithm: Awake Vs GA, Spontaneous ventilation Vs paralysis, Superglottic Vs Infraglottic. (always remember awake intubation under topical anesthesia +/- sedation for expected difficult airway)
- Filp Technique of airtraq insertion (like 180-degree turn while inserting oral airway)
Topics
- PPH (massive transfusion)
- Typhoid fever, CNS involvement
- Neuroleptic malignant syndrome
- Rhabdomyolysis with AKI
- ARDS/ALI
- Brain stem tests/Organ donor support
- Management of increased ICP
- ACS
- Heart block/temp. pacemaker management
- DKA/HONK
- Thyrotoxicosis
- Bronchoscopy
- Adrenal insufficiency
- GBS
- Thrombolysis for ischemic stroke
- Plasma exchange
- Becker myopathy/Inherited myopathy
- Pulmonary embolism
- Major burns/inhalational injury
- VF
- Reperfusion syndrome
- Contrast nephropathy
- Insulin overdose
- Rickettsial infection
- Metformin induced lactic acidosis/other causes of lactic acidosis/metabolic acidosis
- Therapeutic hypothermia
- TB meningitis (with associated hydrocephalus)
- Deep neck space infection and associated complications (e.g. mediastinits)
- Therapeutics of anti-heart failure medications
- "Severe" acute pancreatitis, including hypertriglyceridemia-induced case
- Citrate toxicity during anticoagulation for CRRT
- Venlafaxine toxicity
- Infection of resistant bugs e.g. Acinetobacter, Stenotrophomonas, ESBL, ICBL strain, MRSA...
- Severe/near-fatal asthmatic attack
- Agents for bronchospasm, ventilator management for severe obstructive lung disease
- Difficult-to-control seizures, second-line anticonvulsants
- SLE with multi-organ involvement
- Intubation/extubation strategy for tracheomalacia
- Empyema thoracis
- Dislodged/blocked tracheostomy drill
AIRTRAQ intructional videos
BVM Ventilation for "tooth-less" patient
emupdates.com
BVM should be replaced with LMA ventilation. Aside from that, if this technique is half as effective as they suggest, we need to know about it because we bag a lot of edentulous patients.
aVR - Gets No Respect!
emrap.tv
EMRAP - Emergency Medicine Reviews and Perspectives
Rocuronium Vs. Succinylcholine
vimeo.com
For 8 minute Pecha Kucha competition at Scott Weingart's ED Critical Care Conference, January 13 2010.
