Ever fall asleep on an airplane with the air blasting on your face? Does your nose feel crispier than a crouton? Turns out, the limiting factor for regular nasal oxygen is patient comfort. Despite going through a bubbler, the oxygen is still poorly humidified and cold. This usually limits flow rates to <150 mL/kg/min. For […]
High Flow Nasal Oxygen: Volumax Tips and Tricks
#1: Ensure Disposable Patient Circuit (DPC) is fully seated If not, you may get a misleading “blocked tube” alarm: #2: Leave a slight “S” bend in the Water Inlet Tube The tube connecting the sterile water bag to the unit should not be too loose as this may result in kinks, obstructed flow, and a […]
Subxiphoid (DH) Trifecta
The subxiphoid (DH) view can provide a ton of information. This screen demonstrates the presence of pericardial effusion, pleural effusion, and the gallbladder halo sign. Tip #1: If the heart kisses the diaphragm, significant pericardial effusion is unlikely. Here, the heart is separated from the diaphragm due to effusion. Tip #2: Pleural effusion vs pericardial […]
Status Quo on Status Epilepticus?
Got a patient with seizures that won’t stop? Consider these medications: Midazolam: IntraNASAL 0.25 mg/kg Note the lower dose Consider the use of mucosal atomization device to promote absorption If > 1 mL, split between nostrils May be faster than IV; superior to rectal CRI 0.2-1 mg/kg/h Levetiracetam: 20-60 mg/kg IV q6-8h Phenobarbital: 2-6 mg/kg […]
Wait, we got em back?! Post-Cardiac Arrest Care.
Sometimes the unexpected happens and you get a patient back after they’ve arrested. What’s next? #1: Treat the underlying disease (if known) Things die for a reason. Focus on fixing those issues. If it’s still a mystery, the 5 H’s and 5 T’s are a good place to start: 5 H’s: HypovolemiaHypoxia / HypoventilationHydrogen ions […]