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ICU

Quick Hit Article: Difficult vascular access: You know the drill… but do you really know the drill?

July 23, 2019 //  by Jesse Shriki, DO, MS RDMS FACEP//  Leave a Comment

Kawano et al. Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. Ann Emerg Med. 2018;71:588-596. THE BOTTOM LINE This study was a secondary analysis of a large EMS trial conducted in 7 sites in the US and Canada. This is a really interesting study that looks …

Category: Quick Hit ArticleTag: Cardiology, ICU

LVAD Complications: A review

LVAD Complications: A review

May 18, 2019 //  by Jesse Shriki, DO, MS RDMS FACEP//  Leave a Comment

This is a nice little review by Dr. Long in Dallas entitled: B. Long, J. Robertson, A. Koyfman, et al., Left ventricular assist devices and their complications: A review for emergency clinicians, American Journal of Emergency Medicine, https://doi.org/10.1016/j.ajem.2019.04.050 INTRODUCTION: A ventricular assist device (VAD) can be placed into the right, left, or both ventricles thus …

Category: Quick Hit ArticleTag: Cardiology, ICU

Recent Recommendations in Neonatal Resuscitation 2019 UPDATE

March 11, 2019 //  by Jesse Shriki, DO, MS RDMS FACEP//  Leave a Comment

Sometimes we need a reminder and update on the basics… Your Welcome.. Recent Recommendations and Emerging Science in Neonatal Resuscitation. Pediatr Clin N Am 66 (2019) 309–320. https://doi.org/10.1016/j.pcl.2018.12.002 TIMING OF UMBILICAL CORD CLAMPING  – The 2017 NRP guidelines recommend a 30- to 60-second delay in clamping in all term and preterm infants not requiring resuscitation. – …

Category: BasicsTag: Cardiology, ICU, Pediatrics

Cardiac Arrest in Pregnancy: An 2019 UPDATE

March 11, 2019 //  by Jesse Shriki, DO, MS RDMS FACEP//  Leave a Comment

Sometimes we need a reminder and update on the basics… Your Welcome.. Cardiac arrest in pregnancy. SEMINARS IN PERINATOLOGY 42(2018)33–38.  https://doi.org/10.1053/j.semperi.2017.11.007 MATERNAL PHYSIOLOGY – The maternal heart rate increases by 20–30% or 15–20 beats per minute – Cardiac output increases by 30–50% or 1.8 L per minute with the uterus receiving approximately 17% of maternal cardiac …

Category: BasicsTag: Cardiology, ICU, Obstetrics

Fill the Tank or Rev’ the Engine… WHOA, PUMP the BRAKES: Early fixed dose norepi for septic shock?

Fill the Tank or Rev’ the Engine… WHOA, PUMP the BRAKES: Early fixed dose norepi for septic shock?

March 1, 2019 //  by Jesse Shriki, DO, MS RDMS FACEP//  Leave a Comment

We all know hypotension is bad. But should we fill with fluids or rev up the heart with pressors. This begs the question does early norepi help prevent hypotension and mortality? Today’s quick hit article: Permpikul C, et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER) : A Randomized Trial. Am J Respir Crit Care Med. 2019 Feb 1. doi: 10.1164/rccm.201806-1034OC. PMID 30704260. …

Category: Quick Hit ArticleTag: ICU, Infectious Diseases

Lactate for Safely Screening Sepsis?

February 19, 2019 //  by Jesse Shriki, DO, MS RDMS FACEP//  2 Comments

Fernando  et. al.  HELPFUL ONLY WHEN ELEVATED: INITIAL SERUM LACTATE IN STABLE EMERGENCY DEPARTMENT PATIENTS WITH SEPSIS IS SPECIFIC, BUT NOT SENSITIVE FOR FUTURE DETERIORATION Journal of Emergency Medicine, Vol. 54, No. 6, pp. 766–773. https://doi.org/10.1016/j.jemermed.2018.01.040  BOTTOM LINE: A lactate >4 in this prospective observational cohort study of almost 1000 patients with the “CMS” definition …

Category: Quick Hit ArticleTag: ICU, Infectious Diseases

To B (VM) or Not to B (VM) THAT is the question!

To B (VM) or Not to B (VM) THAT is the question!

February 19, 2019 //  by Jesse Shriki, DO, MS RDMS FACEP//  Leave a Comment

Source: Casey et. al. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. NEJM. February 18, 2019DOI: 10.1056/NEJMoa1812405 Whether ‘tis noble in the mind to suffer the slings and arrows of aspiration or by bagging end them? This is a great methodological (and probably landmark) trial by the impressive authors at Vanderbuilt et al. They have been …

Category: Quick Hit ArticleTag: ICU

SUP-ICU Trial: Pantoprazole in patients at risk for Gastrointestinal Bleeding

December 23, 2018 //  by Jesse Shriki, DO, MS RDMS FACEP//  Leave a Comment

SUP-ICU Trial Kart, M. Pantoprazole in patients at risk for Gastrointestinal Bleeding in the ICU. N Engl J Med 2018;379:2199-208. Trial done in the UK. It was a multicenter, stratified, parallel group, placebo controlled blinded randomized trial.  Included pts admitted to the ICU who were 18 yo or older and had at least one risk …

Category: Quick Hit ArticleTag: GI, ICU

HYPONATREMIA 2.0

HYPONATREMIA 2.0

December 23, 2018 //  by Jesse Shriki, DO, MS RDMS FACEP//  Leave a Comment

HYPONATREMIA PART I – TREATMENT RECOMMENDATIONS IN CASE OF HEMODYNAMIC INSTABILITY, THE NEED FOR RAPID FLUID RESUSCITATION OVERRIDES THE RISK OF AN OVERLY RAPID INCREASE IN SERUM SODIUM CONCENTRATION.  TREATMENT GOALS: An increase by 4-6-mmol/L [Na] is sufficient to reverse most serious manifestations of acute hyponatremia. Increase [Na] no more than 10 mEq/L in 24 hour …

Category: AlgorithmsTag: Cardiology, ICU, Renal

QUICK HIT #11: WHAT TIDAL VOLUME SHOULD BE STARTED IN PATIENTS WITHOUT ARDS

QUICK HIT #11: WHAT TIDAL VOLUME SHOULD BE STARTED IN PATIENTS WITHOUT ARDS

November 22, 2018 //  by Jesse Shriki, DO, MS RDMS FACEP//  Leave a Comment

QUICK HIT ARTICLE Effect of a Low vs. Intermediate Tidal Volume Strategy on Ventilator-Free Days in Intensive Care Unit Patients Without ARDS:
A Randomized Clinical Trial.
Writing Group for the PReVENT Investigators .  Simonis. JAMA. 2018; 320(18):1872-1880 All right pop quiz, hotshot. Altered patient gets intubated in the ED.  He’s almost to the ICU. The RT asks …

Category: Quick Hit ArticleTag: ICU, Pulmonology

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