EEG Monitoring Post-ROSC

Many patients post-arrest are comatose, but are you getting routine EEG’s on your post-cardiac arrest patients? Do you need to? Watch this video to better understand why every comatose patient post-cardiac arrest needs an EEG.  

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Cardiogenic Shock

In this critical care and emergency medicine video, Dr. Colin McCloskey, an EM Intensivist, provides valuable insights on identifying and managing Cardiogenic Shock, a life-threatening condition with a 50% in-hospital mortality rate. He highlights the importance of differentiating it from other shocks, emphasizing key signs such as low systolic blood pressure, narrow pulse pressure, and cool extremities. Echocardiography and bedside physical examination play a crucial role in confirming the diagnosis.

Dr. McCloskey discusses resuscitation, starting with inopressors to defend MAP, with norepinephrine as the first-line choice. Inotropic medications like dobutamine or milrinone may be used if needed to improve cardiac output and coronary perfusion pressure. Mechanical circulatory support devices can be considered when inotropes are insufficient, and a multidisciplinary approach involving heart failure cardiologists, cardiac surgeons, and CT intensivists is crucial for optimal management. Early diagnosis, appropriate medical care, and collaboration among healthcare professionals are highlighted as essential factors in effectively managing Cardiogenic Shock and improving patient outcomes.

Check out his amazing video now!

Critically-ill Obese Patient

In this podcast, Dr. Mike Winters provides insights on managing obese patients in the ICU. He shares a case of a morbidly obese patient who suffered a cardiac arrest during intubation due to rapid desaturation.

Dr. Winters explains that obese patients have little pulmonary reserve and short safe apnea times. To maximize oxygenation, sit patients upright and use NIV or CPAP for pre-oxygenation. Give proper RSI dosing based on total or ideal body weight.

For mechanical ventilation, set tidal volume using ideal body weight. Start with higher PEEP of 10-15 cm H2O and consider a reverse Trendelenburg position. Obese patients have lower lung volumes and higher oxygen consumption.

Clinicians should understand the anatomical and physiological changes of obesity that lead to challenges with intubation and ventilation. Anticipating desaturation, optimizing positioning, and proper dosing of medications can help avoid complications and improve outcomes.

Takeaways

1. Obese patients have little pulmonary reserve and rapidly desaturate during intubation. Pre-oxygenate them upright and use NIV if possible.
2. Use proper dosing of RSI meds based on total body weight (etomidate) or ideal body weight (ketamine, rocuronium). Obese patients are often underdosed.
3. Set tidal volume based on ideal body weight, not total body weight. Consider a slightly higher respiratory rate.
4. Start with higher PEEP (10-15 cm H2O) and place in reverse Trendelenburg position after intubation.
5. Take a multidisciplinary approach involving specialists like cardiologists, surgeons, and intensivists when managing cardiogenic shock. Early diagnosis and treatment are key.