PRESSORS! This post was originally submitted as a summary of many different pressors. It is great to think about them all together, but maybe not digestible in a single bite. If you want to learn about them all at once, watch Dr. Di Taranti's lecture from conference last month. Instead, we will break them down one by one, focusing on a different pressor each week, with the summary table re-presented each week to help compare. Use this as spaced repetition. Each week, remind yourself what the different receptors do. Ask yourself how one medication is different from the last. Ask yourself what dose you would start with and which patients you would use it for.  Review all the pressors, but do it slowly, one bite at a time, and ease yourself in.

A 56 year old male presents to your ED in respiratory distress requiring intubation. During the resuscitation you obtain blood work from his intraosseous device. His K is 6.5.

A patient is brought in by EMS in severe respiratory distress, though o2 sats are normal and lungs are clear on auscultation. You wonder what is triggering the patient's severe tachypnea as you contemplate intubation....

Quick summary of intra-osseous lines: indications, contraindications, complications, placement and accuracy of labs.

Part 2 of Back to Basics: Non-Invasive Positive Pressure Ventilation focuses on BiPAP settings.

Dr. Amish Patel, D.O., dives into these two papers. 

A 23 yo male with a hx of insulin dependent diabetes and recurrent admissions for DKA presents to the ED with complaints of diffuse body aches. He is acutely ill appearing, agitated, and combative with staff, demanding pain medication, entering other patients rooms, and screaming. Realizing that this patient is severely ill, you wonder how you will de-escalate or sedate this patient safely to enable life-saving care to be rendered.....

One out of ten critically ill patients in the intensive care unit (ICU) will develop acute respiratory distress syndrome (ARDS). In addition to low tidal volume ventilation, prone positioning and neuromuscular blockade, adjusting the mechanical ventilation mode may be another strategy to implement early in a patient’s clinical course when faced with ARDS complicated by refractory hypoxemia. 

For mechanically intubated patients in the emergency department, we aim for a tidal volume of 6-8cc/kg of ideal body weight.  But calculating the ideal body weight depends on knowing the patient’s height.  Bedside clinicians have various methods for figuring this out - asking the patient (dif