February 2015 REBELCast

09 Feb
February 9, 2015

REBELCast LogoWelcome to the February 2015 REBELCast, where Swami, Matt, and I are going to tackle two critical care topics that come up frequently in clinical practice in both the pre-hospital setting as well as the emergency department.  Today we are going to specifically tackle:

Topic #1: Administration of Rapid Sequence Intubation (RSI) Medications via an Intraosseous line.

Topic #2: Compressions During Charging (CDC) in Out of Hospital Cardiac Arrest (OHCA)

February 2015 REBELCast Podcast

Click here for Direct Download of Podcast

What clinical questions will be covered in the February 2015 REBELCast?

Question #1: Is the administration of RSI medications via intraosseous (IO) access effective in providing optimal intubating conditions?

Question #2: Does compression during defibrillator charging shorten shock pause duration and/or improve clinical outcomes during shockable out of hospital cardiac arrest?

What specific articles will we be covering?

Article #1: Barnard EBG et al. Rapid sequence induction of anaesthesia via the intraosseous route: a prospective observational study. Emerg Med J 2014. (24963149)

Article #2: Cheskes S et al. Compressions During Defibrillator Charging shortens Shock Pause duration and Improves Chest Compression Fraction During Shockable Out of Hospital Cardiac Arrest. Resuscitation 2014; 85 (8): 1007 – 11. (24830868)

What is the clinical bottom line for the above clinical questions:

Bottom Line #1: IO administration of RSI medications was effective in achieving good intubating conditions and 1st pass success rate was comparable to that seen with IV medication administration.

Bottom Line #2: Compression during defibrillator charging does decrease shock pause duration and improve chest compression fraction in shockable OHCA, but a larger sample size is required to determine the impact of this on clinical outcomes

February 2015 REBELCast Show Notes

For more on the above topics checkout:

 

Bibliography

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Salim Rezaie

Emergency Physician at Greater San Antonio Emergency Physicians (GSEP)
Creator & Founder of R.E.B.E.L. EM

Latest posts by Salim Rezaie (see all)

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5 replies
  1. Eli says:

    Hi,

    I think that since RSI is all about Time so should be gaining a Vascular access. I’m sure we all agree that if an I.V. is not readily available the I.O. route is the fastest.
    What would you consider as fast I.O. application? 10 sec? 30 sec? 1 min? 2 mins? from prep to inject.
    Please share from your experience.
    By the way, i’m using the B.I.G. for several years and evaluating now a new I.O. device called NIO.

    Thanks

    Reply
    • Salim Rezaie says:

      Hello Eli,
      I agree vascular access should be the 1st goal, but in a critical patient if it is taking too long, then I.O. is going to be faster. For me…from prep to placement of I.O. <20 seconds.....TY for your comments and questions and hope this helps.

      Salim

      Reply
  2. Eli says:

    Thank you Salim.
    Very interesting study and podcast.

    Reply

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