Trick of the Trade: Pre-Charge the Defibrillator

In cardiac arrest care it is well accepted that time to defibrillation is closely correlated with survival and outcome.¹ There has also been a lot of focus over the years on limiting interruptions in chest compressions during CPR. In fact, this concept has become a major focus of the current AHA Guidelines. Why? Because we know interruptions are bad.^2,3 One particular aspect of CPR that has gotten a lot of attention in this regard is the peri-shock period. It has been well established that longer pre- and peri-shock pauses are independently associated with decreased chance of survival.^4,5 Can we do better to shock sooner and minimize these pauses?

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By Sam Ghali, MD|2016-12-16T16:05:59-08:00May 16, 2016|CME, Critical Care/ Resus, Expert Peer Reviewed (Clinical), Tricks of the Trade|

Trick of the Trade: Securing the intraosseous needle

So much attention is appropriately focused on the anatomy and technique for intraosseous needle placement. In contrast, very little attention is paid to securing the needle. Often this involves a make-shift setup which involves gauze, wraps, and/or tape. This becomes especially important in the prehospital setting where these can be easily dislodged. The following trick stems from a Twitter discussion in 2015 amongst prehospital providers, lamenting this fact.

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By Michelle Lin, MD|2019-01-28T21:40:34-08:00May 3, 2016|Critical Care/ Resus, Tricks of the Trade|

AIR Pro Series: Critical Care, Part 1 (2016)

Below we have listed our selection of the 12 highest quality blog posts related to 5 advanced level questions on critical care topics posed, curated, and approved for residency training by the AIR-Pro Series Board. The blogs relate to the following questions:

Ultrasound fluid assessment
Ultrasound in critical care
Vasopressors for critical care patients
Peripheral intravenous vasopressor administration
Extracorporeal membrane oxygenation basics

In this module, we have 8 AIR-Pro’s and 4 honorable mentions. To strive for comprehensiveness, we selected from a broad spectrum of blogs identified through FOAMSearch.net.

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By Fareen Zaver, MD|2017-07-21T09:52:08-07:00Apr 20, 2016|Approved Instructional Resources PRO (AIR-Pro Series), Critical Care/ Resus|

Highlights from the 2015 American Heart Association CPR and ECC guidelines

The newest round of the 2015 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) contains 315 recommendations.¹ It is easy to be overwhelmed by this massive (275 pages) document so this post will distill what you need to know in the emergency department. This update marks the end of a 5-year revision cycle for the AHA and the shift to a continuously updated model. Current and future guidelines can now be found at ECCGuidelines.heart.org. This round lacks any of the major foundational changes seen in 2010; however, we do say goodbye to some recommendations (bye bye vasopressin).

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By Sean Kivlehan, MD MPH|2019-09-05T20:30:15-07:00Nov 9, 2015|Cardiovascular, CME, Critical Care/ Resus, Guideline Review|

PV Card: Continuous End Tidal CO2 Monitoring in Cardiac Arrest

For many years, end tidal CO2 monitoring initially was helpful in differentiating tracheal versus esophageal intubations. Now with continuous end tidal capnography, providers have access to so much more information during a cardiac arrest resuscitation, as summarized by the recently released 2015 American Heart Association (AHA) recommendations.¹ Thanks to Dr. Abdullah Bakhsh from Emory University for a great PV card to help remind us of these key cardiac resuscitation pearls.

PV Card: Continuous End Tidal CO2 Monitoring in Cardiac Arrest

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Adapted from [1-4]

References

Link M, Berkow L, Kudenchuk P, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S444-64. [PubMed]
Ahrens T, Schallom L, Bettorf K, et al. End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest. Am J Crit Care. 2001;10(6):391-398. [PubMed]
Silvestri S, Ralls G, Krauss B, et al. The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system. Ann Emerg Med. 2005;45(5):497-503. [PubMed]
Kleinman M, Brennan E, Goldberger Z, et al. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S414-35. [PubMed]

By Michelle Lin, MD|2021-10-19T19:25:31-07:00Oct 20, 2015|ALiEM Cards, Cardiovascular, Critical Care/ Resus|

Your Patient In Extremis: THAM To The Rescue?

One of the final common denominators dictating the success or failure of any resuscitative effort, be it a trauma or medical code, is the patient’s acid-base status. In the presence of acidosis, many of the tools at your disposal, including vasopressors, become impotent and the patient’s ability to strike a balance between bleeding and clotting or mounting an appropriate inflammatory response become deranged.^1–6 So what are the options to tilt the acid-base status in our favor?

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By Prathap Sooriyakumaran, MD|2016-11-11T19:39:36-08:00Oct 5, 2015|Critical Care/ Resus, Expert Peer Reviewed (Clinical), Tox & Medications|

Trick of the Trade: Squeeze test for confirmation of IO placement

Venipuncture is the most common invasive procedure performed in the emergency department ¹ , likely due to the fact that the vast majority of our laboratory evaluations require blood and many of our life saving interventions require access to the patient’s systemic circulation. Most of the time emergency department staff are able to perform this procedure easily, but occasionally you find that your patient is the dreaded “difficult stick”. Literature suggests that the landmark technique is successful on the initial venipuncture 74-77% of the time. ^2–5 Success rates rise after multiple attempts, but what happens when you don’t have the luxury of time? What happens when your patient will die if you don’t get life saving medications into their circulation promptly? There are a few options when you can’t get IV access through traditional means, among them external jugular vein cannulation, central line, ultrasound-guided IV, and the intraosseous lines (IO).⁶ However, when managing the crashing patient, a wise decision is to use the quickest option, which is often the IO.

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By Jailyn Avila, MD, RDMS (She/Her)|2020-01-15T23:56:42-08:00Jul 22, 2015|Cardiovascular, Critical Care/ Resus, Tricks of the Trade|

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