That’s fair enough about DVT
I find in pretty difficult to get really good images in the ambulance or aircraft, but they are often good enough to help. The IQ3 is a modest improvement for cardiac
Like I’m super on board with criticizing this administration but I’m not sure there’s a concern about this quality of fentanyl and suspect it’s similar to other administrations.
Presumably that’s just on hand for emergencies and that’s like at most a few ambulances/paramedics worth of fentanyl.
Related ish question
You ever do DVT ultrasound for these patients?
I haven’t yet but am learning.
Lovely POCUS images, especially with a butterfly!
From a prehospital standpoint I tend to start with norepinephrine as well it rarely wrong
the inotropy of epinephrine on the RV are likely helpful and I’ll add it pretty early for a suspected PE patient(at like 8-15 mcg/min of norepi)
I love that this is viewed an extremely wasteful use of air transport and a critical care transport team
I feel like a min ventilation of 200 ish mls/kg/ min without to much trouble which usually gets you a paco2 of about 20-25 mmhg
Seems like a reasonable goal
I'm revising the IBCC septic shock chapter based on ANDROMEDA-SHOCK II
would love any feedback & critique on this
ANDROMEDA algorithm is nice, but it's too complicated for everyday use. We need something simpler.
& maybe it's time to push for IR thermography 😍
emcrit.org/ibcc/sepsis/... #EMIMCC
This is really good!
My only question thought is
Should the vasopressor challenge have two versions?
One simply aiming for a DBP > 50 and then another for MAP > 80 ?
It seems like many patients improved CRT with DBP >50 alone
🫀SCCM 2024 - Guidelines on Adult Critical Care Ultrasonography 🏥:
Conditional recommendations-
🫢 Acute dyspnea / resp failure
💧 Targeted volume management
❤️ Cardiogenic shock
🦠 Septic shock
+/-⚖️ Cardiac arrest
#POCUS #ICU #PCCM @sccmcriticalcare.bsky.social
tinyurl.com/5a7w3k8k
Largest ever study of peripheral 23.4% NaCl with 863 administrations 😀
Some extravasation did occur, but it *didn't* lead to any major problems (tissue necrosis etc)
If someone is having an ICP crisis, you should worry about their BRAIN and not their ARM - their arm will be fine #EMIMCC
@joshkimbre.bsky.social getting cited by the updated ACLS guidelines about pacing is pretty cool.
Great paper if you haven’t read it
pubmed.ncbi.nlm.nih.gov/38407212/
I really like those things, another great option is multi lumen PIVs which I wish were more widely available.
I have seen this happen, and while it wasn’t a huge deal I can imagine patients who could be harmed by it.
Not to say you can’t/shouldn’t run other things with pressors, just that you need to be careful
This actually can be a problem depending on how things are set up and the concentration of norepinephrine used.
For example we tend to use 64 mcg/ml norepinephrine and let’s say the deadspace in the line is 2mls and now you want to start a bolus could possibly give all of that rapidly
For sure, very niche use cases
It makes sense for some small ambulance services or maybe crash carts in the hospital
We’re talking about getting it as a backup to the glide scope at my HEMS job
Glidescope go is fantastic, UE scope and intersurgical Iview are great lower cost alternatives
On the monitors I use you only get it if you get a 12 lead ECG and it seems accurate enough for most clinical use
I assumed the qtc from hospital monitors was similar
You run in to difficulties with the computer QTc ?
In case anyone is wondering the answer is that it absolutely is that dangerous.
But it makes the Etco2 higher! Isn’t that good? Don’t you want the patient to live?
AOC: I want to live in an America that guarantees healthcare to every person.
I want to live in an America that has a living wage for every person
I want to live in an America where you have free speech to express yourself and not be afraid of being put on a list or deported.
This is really worrisome
Missouri has been running the pilot for Project 2025 for a couple of decades.
With a GOP Supermajority, over 30% of our schools are on a four-day week. We fund vouchers for private religious schools. Our starting teachers are 50th in the nation for pay and they pay for their own supplies.
That’s interesting and not my experience(but prehospital may be different from in hospital)
Only the lifepack brand defibs have the ability to increase beyond 200j
My understanding was that there was no convincing evidence that Zoll 200 j was less effective than lifepack 360j. And some poor quality evidence that zoll is better despite less energy
But there may be some evidence I’m not aware of
May bolus as well or just start the drip?
Agree or disagree?
My top tip after a week of ICU
- 15mm and 22mm connections in airway circuits aren’t perfectly circular
- pushing them together, they can just come apart quite easily
-push *and twist* and they sort of jam together and are much more secure
✨Push and twist for breathing circuit happiness ✨
