Archive for category: Critical Care

Simplifying Mechanical Ventilation – Part 3: Severe Metabolic Acidosis

18 Jun
June 18, 2018

Before I set up the ventilator, I consider if my patient has one of the following 3 physiologic processes: severe metabolic acidosis, an obstructive process (Asthma or COPD), or refractory hypoxemia. If my patient doesn’t fit into one of these 3 categories then I will default to placing them in the refractory hypoxemia category (Part […]

Sodium Bicarbonate in Cardiac Arrest Management

15 Jun
June 15, 2018

Background: As with all medications in cardiac arrest (i.e. epinephrine, amiodarone) the benefits of sodium bicarbonate administration have been discussed and debated for decades. While it is clear that sodium bicarbonate can play a role in resuscitation of arrest due to hyperkalemia, it’s role in patients with acidemia resulting from or causing arrest is unclear. In […]

Simplifying Mechanical Ventilation – Part 2: Goals of Mechanical Ventilation & Factors Controlling Oxygenation and Ventilation

18 May
May 18, 2018

In part 1, we discussed that the ventilator can deliver 3 types of breaths: controlled, assisted or spontaneous breaths. These breaths can be delivered either by a set pressure or a set tidal volume. Then we closed with a discussion of the common ventilator modes, which is simply just combining all these types of breaths […]

RSI, Predictors of Cardiac Arrest Post-Intubation, and Critically Ill Adults

10 May
May 10, 2018

Background:Intubation is a commonly performed procedure in the ED and ICU. We have discussed the physiologically difficult intubation before on REBEL EM.  One of the tenants in managing these patients is “resuscitate before you intubate.”  Two publications in the past [1][2] discussed the incidence and risk factors associated with cardiac arrest complicating RSI.  In the first […]

REBEL Cast Episode 50 – Intoxicated Patients can Equal Badness

07 May
May 7, 2018

Background: Visits to the ED for alcohol intoxication can create quite the clinical conundrum both for acute medical and traumatic reasons.  Acutely intoxicated patients, just like young kids, don’t always have the ability to communicate due to sedation, agitation, or some other critical medical/traumatic process that is ongoing.  This makes getting a complete history or […]

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