May 23, 2019
Author: Gretchen Hinson, MD
Educational Pearls:
- In most healthcare settings, normal saline (NS) has become ubiquitous as an intravenous fluid despite some potential drawbacks
- Compared to normal saline, a balanced crystalloid (either lactated Ringer’s or Plasma-Lyte) was associated with a lower composite endpoint of...
May 5, 2019
Author: Ryan Circh, MD
Educational Pearls:
- The 2019 ANDROMEDA-SHOCK trial compared using serum lactates to capillary refill assessment in septic shock patients to guide resuscitation
- Capillary refill time was standardized (this is not straightforward):
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- A glass microscope slide was pressed on the ventral side of the...
Mar 8, 2019
Author: Michael Hunt, MD
Educational Pearls:
- Bedside transtracheal ultrasound to confirm proper endotracheal intubation is simple and effective
- Review of 17 studies showed transtracheal ultrasound was was 98.7% sensitive and 97.1% specific
- Curvilinear probe may be preferable as it provides a larger field of...
Mar 6, 2019
Author: Aaron Lessen, MD
Educational Pearls:
- Dyspnea can occur in up to 50% of intubated patients
- Dyspnea is associated with prolonged mechanical intubation
- Often goes undiagnosed as these patients have difficulty communicating
- Expert opinion on reducing sensation of dyspnea
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- Reduce stimulation of respiratory drive...
Jan 30, 2019
Author: Aaron Lessen, MD
Educational Pearls:
- Choose the longest needle for the humeral IO
- Internally rotate and adduct the patients hand (resting on umbilicus) for best access to the site
- Aim 1 cm superior to the greater tuberosity of the humerus with the needle angled 45 degrees inferiorly
- Maintaining the line is...