Emily Damuth, MD

#Name that Mode…and a ventilator alarm is firing!

Editor: 
Emily Damuth, MD

An 82-year-old woman is mechanically ventilated for acute respiratory failure following acute intracerebral hemorrhage. Her FiO2 has been 30% with an arterial blood gas showing adequate ventilation and oxygenation for the last 24 hours (7.43/37/89/25). Suddenly, the ventilator alarms for low exhaled tidal volume. On bedside evaluation, her SpO2 is 84%, respiratory rate 20 breaths per minute, HR 124 beats per minute and blood pressure 105/65 mm Hg. Her ventilator graphics before and after the alarm are depicted below. What mode of mechanical ventilation is she receiving and what triggered the alarm? 

 

Emily Damuth, MD
Tags: 
mechanical ventilation
ventilator waveforms
ventilator alarms
Fri, 11/22/2019 - 1:00am
Topic: 
Critical Care
Category (Day): 
Friday

Deviation from Standard ACLS: Esmolol for Refractory VF/VT

Editor: 
Emily Damuth, MD

You have a patient in cardiac arrest getting high quality CPR with an initial rhythm of pulseless VT that has been defibrillated three times and received a total of 3 mg of epinephrine and a loading dose of 300 mg of amiodarone. As you continue ACLS, the patient remains in VT. Are there alternative treatments to consider? 

 

 

Tom Sewatsky, MD
Tags: 
VF
pulseless VT
ACLS
electrical storm
Fri, 11/08/2019 - 4:58am
Topic: 
Critical Care
Category (Day): 
Friday

Tracheostomy Emergencies

Editor: 
Emily Damuth, MD

A 44-year-old man with a history of cardiac arrest complicated by hypoxic-ischemic encephalopathy presents to the ED in respiratory distress. He underwent tracheostomy 2 weeks ago for acute respiratory failure and was subsequently weaned to trach collar. He developed acute onset of respiratory distress at rehab this morning and now presents to the ED with acute hypoxic respiratory failure. On exam, he is hypertensive (169/88), tachycardic (HR 178), tachypneic with respirations assisted with bag-valve mask (BVM) ventilation and hypoxemic (SpO2 87%). What is your approach to the management of tracheostomy emergencies?

Emily Damuth, MD
Tags: 
Tracheostomy
mechanical ventilation
Fri, 10/25/2019 - 5:45am
Topic: 
Critical Care
Category (Day): 
Friday

Mechanical Ventilation Alarms: High Airway Pressure

Editor: 
Emily Damuth, MD

You are called to the bedside of a mechanically ventilated patient for an alarm that is being triggered on the ventilator. In red and blinking you see “Airway pressure high.” What’s your next move?

 

Tom Sewatsky, MD
Tags: 
mechanical ventilation
peak pressure
plateau pressure
compliance
resistance
Fri, 10/11/2019 - 5:22am
Topic: 
Critical Care
Category (Day): 
Friday

Ventilator graphic analysis: Obstructive lung disease

Editor: 
Emily Damuth, MD

Analyzing ventilator waveforms in a patient with acute respiratory failure is as essential as monitoring the telemetry of a patient with suspected cardiac dysrhythmia. What life-threatening complication is demonstrated in the ventilator graphics? 

 

Emily Damuth, MD
Tags: 
mechanical ventilation
ventilator graphics
intrinsic PEEP
auto-PEEP
Fri, 10/04/2019 - 5:00am
Topic: 
Critical Care
Category (Day): 
Friday

Pressure regulated volume control (PRVC): Is it a “volume control” or “pressure control” breath?

Editor: 
Emily Damuth, MD

Dr. Phil Dellinger, master of mechanical ventilation, breaks down Pressure Regulated Volume Control (PRVC) by discussing the breath type delivered in this mode of mechanical ventilation.  

Tags: 
mechanical ventilation
breath type
trigger
cycle
Fri, 09/27/2019 - 6:45am
Topic: 
Critical Care
Category (Day): 
Friday

Pages