31 Dec 2020

December 31, 2020

Written by REBEL Crit
Introduction: Respiratory failure is an uncommon but important complication in pregnancy and the postpartum period, occurring 1 in 500 pregnancies.1 Respiratory failure can result from pregnancy-related conditions, conditions exacerbated by pregnancy, or pathologies common to the general population (Table 1). Understanding of respiratory failure and mechanical ventilation in pregnant patients is limited by the relative rarity of the condition as well as the exclusion or underrepresentation of pregnant patients in the majority of the trials that have informed our understanding of respiratory failure. As such, respiratory failure in this vulnerable population is a stressful emergency that requires understanding of the anatomical and physiological changes of gestation as well as meticulous preparation for a difficult airway. 
Medical Categories: Obstetrics and Gynecology, Resuscitation
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21 Dec 2020

December 21, 2020

Written by REBEL Crit
Background:  Vasopressors are usually given through central venous catheters (CVC). This, however, is a time-consuming process and placement of a peripheral venous catheter (PIV) is much faster. Each hour of delay has been associated with a 2% increase in in-hospital mortality.2 Using PIV for the infusion of vasopressors can be an effective alternative for time-sensitive patient care in the emergency department (ED). Previous studies, however, have been inconclusive regarding complications of vasopressor infusion through PIV.
Medical Categories: Resuscitation
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14 Dec 2020

December 14, 2020

Written by REBEL Crit
Background: In the US out-of-hospital cardiac arrest (OHCA) has an estimated survival rate of <10% overall, but slightly better survival rates with shockable rhythms of approximately 30% [2]. A small proportion of these patients will have refractory VF/VT OHCA not treatable by standard ACLS guidelines.  One possible modality for these patients is extracorporeal membrane oxygenation (ECMO, followed by immediate coronary angiography and percutaneous coronary intervention (PCI).  How would this ECMO-facilitated resuscitation strategy fair when applied in a US metropolitan community?
Medical Categories: Resuscitation
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19 Nov 2020

November 19, 2020

Written by REBEL Cast, REBEL Crit
Background Information: Central venous catheterization is a common procedure performed in the ICU for the purposes of drug administration and resuscitation. The subclavian vein is the more preferred access site given its fixed puncture location, ease for nursing access and low incidence of infections.1 Landmark guided catheterization has a widely variable success rate and has been shown to increase the risk of complications such as hematoma formation and pneumothoraxes.2,3 The use of real-time ultrasound guidance has thus led to more central lines being placed in the internal jugular and femoral lines, however there is substantial debate regarding its use in subclavian vein catheterization.4,5 The authors of this study sought to compare the efficacy and safety of static ultrasound-guided puncture with traditional anatomic landmark guided subclavian vein puncture.
Medical Categories: Procedures and Skills, Resuscitation
2 Likes
9 Nov 2020

November 9, 2020

Written by REBEL Crit
Background/Introduction: The use of Sodium Bicarbonate (SB) in cardiac arrest has had a complicated history with strong and varied opinions on its effectiveness. SB was recommended in earlier ACLS guidelines, mostly stemming from the notion that severe metabolic acidosis due to hypoxia and hypoperfusion during cardiac arrest led to impaired myocardial contractility, decreased effectiveness of vasopressors, and increased risk of dysrhythmias. Subsequent data called into question the benefits of SB in cardiac arrest and highlighted potential harms such as hypernatremia, hyperosmolarity, metabolic alkalosis, as well as reduction in ionized calcium, vascular resistance, and extracellular fluid volume expansion. This led to the 2010 ACLS guidelines stating that routine use of SB is not recommended (Class IIIB) and that it may be considered in special circumstances (preexisting metabolic acidosis, Hyperkalemia, or TCA overdose). Despite this, the use of SB during cardiac arrest is still common in emergency departments with varying opinions on its effectiveness. In fact, recently published data from the National Emergency Medicine Services Information System (NEMSIS) noted that besides epinephrine and normal saline, sodium bicarbonate was the third most commonly used medication in out of hospital cardiac arrest (Chan 2020). This study aimed to consolidate the state of evidence behind the use of SB in cardiac arrest.
Medical Categories: Resuscitation
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