On Deeper Reflection Episode on 3 words of dissatisfaction Should, Must, Won't

see shownotes at https://emcrit.org/342

.

.

.

Taking Cardiogenic Shock Management to the next level...

Some dozen years ago, a couple of my buddies and I created the RUSH exam. Today, I give you an update:

An update on push-dose pressors

blood bank stuff: The basics of crit care transfusion medicine

The hands-on of orchestrating a massive transfusion protocol

When hyperthyroidism goes really wrong...

Enough with cook book medicine and courses for dermatologists--let's provide cutting edge intra-arrest care

My favorite part of SMACCgold; buy some Cricolol

Can we give vasopressors peripherally? And if we do, what if they leak?

It is winter and that means cardiac arrests coming in with extremely low body temperatures after environmental exposure. How do you treat these patients? How do you rewarm if you don't have bypass?

Note: Please listen to the PDP update episode either before or immediately after listening to this one Finally a non-intubation topic! Bolus dose pressors and inotropes have been used by the anesthesiologists for decades, but they have not penetrated into standard emergency medicine practice. I don’t know why. They are the perfect solution to short-lived hypotension, e.g. post-intubation or during sedation. They also can act as a bridge to drip pressors while they are being mixed or while a central line is being placed. Click Here for printable sheet with mixing instructions Epinephrine Do not give cardiac arrest doses (1 mg) to patients with a pulse Has alpha and beta-1/2 effects so it is an inopressor Onset-1 minute Duration-5-10 minutes Mixing Instructions: Take a 10 ml syringe with 9 ml of normal saline Into this syringe, draw up 1 ml of epinephrine from the cardiac amp (amp contains Epinephrine 100 mcg/ml) Now you have 10 mls of Epinephrine 10 mcg/ml Dose: 0.5-2 ml every 1-5 minut

Here it is, the 1st EMCrit podcast. It's on the topic of Sympathetic Crashing Acute Pulmonary Edema (SCAPE). This condition is on a very different part of the disease spectrum from FOPE (Fluid-Overload Pulmonary Edema, an acronum I first saw used by by @Cameronks) To boil it down to 10 seconds: Start patient on Non-invasive ventilation with a PEEP of 6-8; quickly titrate to a PEEP of 10-12. Start the patient on a nitroglycerin drip. Administer a loading dose of 4oo mcg/min for 2 minutes (120 ml/hour on the pump for 2 minutes with the standard nitro concentration of 200 mcg/ml.) Then drop the dose to 100 mcg/min and titrate it up from there as needed. By 10 minutes, your patient should be out of the water. See crashingpatient.com for the references.   Here is some info from a handout from a lecture I gave on the topic: High Dose Nitroglycerin Homeopathic nitroglycerin does not work so well Start at 50-100 mcg/min, you can rapidly titrate to 200-400 mcg/min. You must stand at the bedside

In which I introduce you to me and explain what this whole thing is about. (better late than never)