We're back with another Last Week Now. Let's see what we were up to last week. :
- Mechanical vs. Manual CPR...which should you use?
- A fantastic Tweetorial on hemodynamic monitoring Should we ditch direct laryngoscopy for video?
- Awake intubation by Dr. Laura Duggan
- Grand Rounds this week with Dr. Dan Patino
- Are you down with ProCalcitonin? Dr. Eddy Gutierrez breaks it down
We are closing registration for the ResusX:ROSC conference this week so if you were thinking of going, now is the time to register!
Let's get right to it...it’s time for Last Week Now!
Do you use mechanical CPR devices? What's the evidence? I go over it all in this video. Spoiler alert.....it's not as easy as it sounds. Let me know your thoughts in the comments section.
Click here for the video.
A Tweetorial of Hemodynamics
If you don't follow @IM_Crit_, you should. Check out this tweetorial below on hemodynamic assessment and monitoring. It's a create review to go through, but I've provided some of the highlights here:
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Intracardiac Pressure Waveforms: The tweet discusses the importance of understanding the waveforms derived from the pulmonary artery catheter. It mentions the gradient between the PA diastolic pressure and the mean PCWP, which ensures forward blood flow through the pulmonary vasculature.
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Cardiac Preload: The gold standard for assessing cardiac preload is the LV end-diastolic pressure (LVEDP), which is measured with a catheter retrogradely crossing the aortic valve into the LV. The pulmonary capillary wedge pressure (PCWP) is a good surrogate of LV preload, but in about 30% of heart patients, LVEDP was >5mmHg higher than PCWP.
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LV Wall Tension: The LV wall tension is described by Laplace’s equation, which states that a dilated LV (with increased ventricular radius) will have to develop a higher inward force than a smaller heart to generate the same systolic pressure. Conversely, a hypertrophic LV will achieve a lower wall stress and more easily generate a systolic pressure that overcomes ventricular afterload.
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Arterial Impedance: The left ventricle, when contracting, has to overcome not only what happens in the aorta but also what happens throughout the arterial tree. This is known as arterial impedance, and its three major determinants are resistance, compliance, and inertia.
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Afterload: The tweet discusses the concept of afterload and how it is affected by LV wall stress and aortic impedance. It also mentions the concept of ventriculo-arterial coupling, which is important for understanding the relationship between the ventricle and its afterload.
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Afterload Mismatch: This is the concept of matching between the afterload and the inotropic state of the heart. A mismatch can be induced acutely in a normal heart if end-diastolic volume is not allowed to compensate (or cannot compensate!) for the increase in afterload.
This is a summary, click below to read more.
Refresher on Hemodynamics:
— IMCrit (@IM_Crit_) June 20, 2023
From: Cardiovascular Hemodynamics. An Introductory Guide. Arman T. Askari, Adrian W. Messerli. Springer International Publishing; 2019 pic.twitter.com/uc94TR1gVj
Prof. Laura Duggan from the University of Ottawa recently shared valuable insights on awake intubation in an educational YouTube video. She emphasized the importance of these techniques for handling airway trauma, noting that awake intubation is still required in about 1% of cases, despite advancements like video laryngoscopy (VL).
Duggan detailed the procedure of awake intubation, advising the use of glycopyrrolate to manage secretions and heart rate, cautioning against sedation, and walking viewers through the process of topicalization using 4% lidocaine and atomizers. She also highlighted the importance of targeted topicalization for optimal patient comfort and successful intubation, recommending 5% lidocaine paste for glossopharyngeal nerve anesthesia.
The video concluded with a review showing no significant difference between using flexible scopes and VL for awake intubation. Duggan encourages clinicians to consider both techniques based on individual case specifics. This video serves as an essential resource for clinicians, highlighting the need for skill development, evidence-based decision making, and patient-centered care in awake intubation.
Watch the video here for the entire video from Laura.
In this episode, Eddy Jo delves into the complexities surrounding the use of procalcitonin as a biomarker for bacterial infection. Procalcitonin is typically secreted in response to inflammation and pathological situations such as bacterial infections and certain chronic conditions like end-stage renal disease or cancer. Eddy also explores the limitations and misconceptions about procalcitonin, such as its inability to definitively diagnose bacterial infections or differentiate between bacterial and viral infections.
The FDA's recommendations regarding procalcitonin levels for initiating or stopping antibiotic treatment are discussed, as well as the potential issues that arise when practitioners rely too heavily on procalcitonin values in a clinical setting. The host explains that data has shown the use of procalcitonin to diagnose bacterial infection is not as straightforward as some practitioners might think. He concludes by suggesting that while procalcitonin might not be a reliable tool for initiating antibiotic treatment, it could have some utility in determining when to stop such treatments, particularly in places where antibiotic use is high.
Sign up here for the incredible cardiac arrest conference, ResusX:ROSC Conference happening July 11 & 12, 2023.
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Sign up for Grand RoundsDominating the Clot!
We're excited to welcome Dr. Dan Patino to the June edition of the RX Rounds. Dr. Patino is an educator and a resuscitationist. This month he will be discussing how to resuscitate the patient with a hemodynamically significant pulmonary embolism.
The lecture will be 25 minutes long and is open to everyone. If you are a ResusNation or ResusX All-Access member, you're invited to our private Q&A session with Dan after his talk. Ask him questions about PE's, resuscitation, or anything you like! You don't want to miss the lecture or the post-talk Q&A!
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