An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
Your patient needs an airway. What is your go-to tool for endotracheal intubation? Do you reach for direct laryngoscopy (DL) and just get it over with? Or do you wait until the whole setup gets brought into the room to attempt a video laryngoscopy (VL)? The debate of DL vs. VL for intubation has persisted …
Continue reading Direct (DL) vs Video Laryngoscopy (VL) for Intubation? DEVICE Trial
With so many simultaneous issues transpiring in our critically ill patients, it is naive to think that one lab marker or one calculation would tell an absolute story. This has led to the erroneous mindset that every time the lactate is elevated, the patient has sepsis when we know that is not true. Another such …
Continue reading RSBI (Rapid Shallow Breathing Index) for Extubation Success? Nope.
The pendulum has swung when it comes to deciding when to proceed with intubation of our COVID-19 patients when it comes to timing. The early data suggested early intubation was the way to go as we were all terrified or aerosolization of the virus caused by the high-flow nasal oxygen or different modes of non-invasive …
Continue reading Timing of Intubation in COVID-19 Patients: Early or Late?
I remember like it was yesterday the first COVID patient who I intubated. I was scared. Heck, I still have a healthy respect for the procedure because these patients don’t do well on the vent. In addition, they tend to tank their O2 sats as soon as the RSI drugs kick in. Everything needs to …
Continue reading Intubation/Extubation: a High-Risk Aerosol Generating COVID Procedure?
Sometimes medicine behaves like the stock market; a whole bunch of enthusiasm followed by a realistic pullback. This has now occurred with the concept of using one ventilator for multiple patients. I agree that we need to use some ingenuity in this crisis, but this one never sat well with me, hence me not commenting …
Many questions on how to extubate these patients. There's no right answer yet. I've read of a high reintubation rate for these patients and cardiac arrest after extubation we need to be prepared for that. This is a living, breathing document. I would like to make changes as you all point out things that I have missed. Let's attempt …
Continue reading COVID-19 Extubation Protocol (in the works)
Not every patient reads the textbook, but you and I have to know where to start when managing our patients who have hypercapnic respiratory failure that we want to treat with non-invasive ventilation (or what you and I frequently call BiPAP). This NIV algorithm is taken from the British Thoracic Society/Intensive Care Society Acute Hypercapnic …
Continue reading Non-Invasive Ventilation (NIV/BPAP/BiPAP) Algorithm.
A sentinel event is one where, amongst other different outcomes, leads to death. In critical care, anesthesia, and emergency medicine, we often deal with emergent airways on patients who are on the brink of death unless we intervene expediently. Despite having performed many intubations in my young career, I have the utmost respect for every …
Continue reading Pre-oxygenation: High flow nasal cannula vs. BVM
What are your experiences with ketamine for intubation? I am really glad that I stumbled onto this article that was shared by @the_resuscitationist and @medicotactico. When you're dealing with airways and medications that have can concerning adverse effects, you really shouldn't trust me on anything and should read the article yourself. Link in bio. This one is …
Continue reading Ketamine for Rapid and Delayed Sequence Intubation
The quick and easy answer to how much volume is in the BVM ventilation bag (the part you squeeze) in an adult resuscitator is 1600ml.You hear the alarm go through the hospital "CODE BLUE in room XYZ". You, like me, are an ambulance chaser and want to get there as soon as possible to either …
Continue reading How much volume is in an adult resuscitator (BVM)? 1600ml