Lars-Kristofer Peterson, MD

Low Tidal Volume Strategy for Patients without ARDS; Takeaways from PReVENT

EMS brings in a 67 year old male in a PEA arrest. ROSC is obtained after twenty minutes of downtime. He was intubated by EMS during transport. A colleague talks to the family and she lets you know that he was complaining of shortness of breath and chest pain for an hour before he had a witnessed cardiac arrest and that his PMH includes HLD and HTN. The respiratory therapist is asking for the ventilator settings.


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Should the Pulse Oximetry be an A or A+?

A patient has arrived with increased work of breathing, hypoxia, and altered mental status requiring intubation.  After intubation, the patient stabilizes and their oxygenation improves. You know that both hypoxia and hyperoxia are bad for patients and that initial ED mechanical ventilation strategies are often continued after admission1.  How can you titrate the patient’s fraction of inspired oxygen (FiO2) to keep them safe from both hypoxia and hyperoxia?

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Initial choice of anticoagulation in PE

Case: A 34 year old female with no PMHX presents to the ED with unilateral right lower extremity swelling, dyspnea, and moderate pleuritic chest pain.  Vitals: BP 130/65, HR 68, RR 20, SPO2 89% on room air, Temp 37.8. A CT finds evidence of PE bilaterally at the segmental level. BNP and troponin are both mildly elevated.  Point of care cardiac ultrasound shows mild RV dilation. After interviewing the patient, you don’t identify any contraindications to anticoagulation. Pregnancy testing is negative.  Her renal function is normal. You consider what is the preferred agent for anticoagulation in this patient.

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