We have lots of juicy stuff for you this week so let's get right to it. Here’s what happened last week:
- A TikTok to help your Seldinger skills
- A free course on BVM skills from Cliff Reid
- A podcast on unstable atrial fibrillation from Sara Crager
- Registration for the ResusX:ROSC is live and tickets are selling fast!
- A podcast on massive GI bleeds
- This week we have our May Grand Rounds on LVADs with Dr. Colin McCloskey
There’s no time to waste, it’s time for Last Week Now!
If you have trouble passing the wire into a dilator or catheter, this video is for you. Part of the frustration is getting a tiny wire tip into a small hold so I made this video to show one technique to help. After you watch the video, read the comments too, because lots of people shared their techniques with me.
Enjoy the video.
A Free Course in Bag-Valve-Mask Ventilation
My friend Cliff Reid is an amazing educator. One of things he does is makes sure that basic skills are done well. To that end, Cliff released a free course on BVM skills for anyone to take. Proper BVM skills is something that people think is easy, but it is sometimes done wrong.
Cliff puts on this course that provides an overview of basic bag-valve-mask (BVM) ventilation techniques to assist with ventilation in patients who are not intubated. It is divided into three sections and also includes a short five-question multiple choice quiz to help reinforce the concepts covered. The overall objective is to enhance understanding and proficiency in utilizing a bag-valve-mask device for ventilation. Active engagement and completion of the feedback form are encouraged to maximize the benefits of this educational resource.
Check the link to the course here, and please share with anyone that you think this would help. Thanks Cliff!
In this week's ResusX Sara Crager discusses the management of Unstable A-Fib (Atrial Fibrillation). She highlights the importance of distinguishing between primary and secondary causes of instability before considering immediate cardioversion. Sara emphasizes that not all patients with A-Fib and low blood pressure require immediate intervention. Factors such as fluid status, electrolyte levels, and sympathetic activity should be evaluated to determine the underlying cause of instability. Sara advocates for a comprehensive approach that goes beyond the choice between beta blockers and calcium channel blockers. She introduces seven key questions to guide the management of Unstable A-Fib, including primary versus secondary causes, rate versus rhythm issues, the necessity of immediate cardioversion, electrolyte correction, fluid status assessment, and the use of appropriate medications. Sara suggests considering Amiodarone as a go-to option for rate and rhythm control in unstable A-Fib cases, while also addressing blood pressure support with medications like phenylephrine or vasopressin. Overall, this video provides valuable insights and strategies for effectively managing Unstable A-Fib. Check out https://www.resusx.com for education on resuscitation #UnstableAFibManagement #CardioversionConsiderations #PrimaryVsSecondaryCauses #FluidStatusAssessment #ElectrolyteCorrection #ComprehensiveApproach #AmiodaroneForRhythmControl #BloodPressureSupport #AtrialFibrillationInsights
Watch the video here for the entire video from Sara.
This episode of the ResusNation Podcast features Dr. Jenn Repanshek. When dealing with patients presenting with massive upper gastrointestinal (GI) bleeds, emergent management plays a crucial role in saving lives. Here are some summary points from the podcast.
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- Differentiating between patient perception and medical definition of massive upper GI bleeds is crucial.
- Rapid and effective resuscitation is vital, as these patients can deteriorate rapidly without warning.
- Initial steps include wearing personal protective equipment (PPE) and assessing the patient's airway, breathing, and circulation (ABCs).
- Volume resuscitation is a priority, using large-bore peripheral IV or central access if necessary.
- Nasal cannula for oxygenation, continuous monitoring, and early consideration of intubation are essential.
- Prompt activation of a massive transfusion protocol may be necessary for patients with massive upper GI bleeds.
- Clinical assessment guides transfusion requirements rather than relying solely on lab results.
- Intubation should be delayed until adequate resuscitation has taken place to prevent poor outcomes.
- Consideration of various treatment options (endoscopy, embolization, surgery) involves consulting with GI, IR, and surgical colleagues.
- Additional medications like PPI and octreotide may not have significant benefits during the initial resuscitation phase.
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