Friday

Initial choice of anticoagulation in PE

Editor: 
Lars-Kristofer Peterson, MD

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.

Lars-Kristofer Peterson, MD
Fri, 11/01/2019 - 6:00am
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

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