The Educational Newsletter From CriticalCareNow!
Welcome to this week's newsletter. We've got a ton of stuff to cover with you, so let's get right to it.
- Registration for ResusX:Reset is now open! Limited tickets are available for the live event in Philadelphia. There is also a virtual option if you cannot attend live. This event combined with the one-day UltraRounds pre-conference promises to be the biggest conference of 2023.
- Ketamine can't hurt my patients....right? Size matters, when it comes to ketamine dosing.
- The Neuro Crit Care Queen, Dr. Evie Marcolini, talks about managing ICP.
- Salim Rezaie (@RebelEM) asks the question, is there a max dose for norepinephrine and brings the receipts from the literature.
- The August ResusNation lectures have been released...spoiler alert, they're awesome!
- Is it a STEMI or an OMI? Dr. Pendall Meyers introduces a new framework for this
- A Chris Reilly is back talking chest tubes for hemothorax
Let's get ready to get our learn on with this week's review....it's time for Last Week Now!
Limited Registration is Open!
Early-Bird registration is now open for ResusX:Reset. Save over 25% right now when you register. You have two options to watch ResusX, attend live in Philadelphia or stream it. Either way you'll be attending the biggest resuscitation event of 2023.
ResusX:Reset Live
Come to Philadelphia and watch the rockstars of resuscitation present live, witness debates, participate in hands-on workshops, interact in small group sessions, simulation, and so much more. Stay after 5pm each day and interact with the conference faculty for drinks and food. This is not a conference, it's an experience. A Hilton hotel block has also been arranged for you and is less than 5 minutes away from the venue. Tickets are extremely limited this year to ensure we give you most hands-on, intimate, and exclusive experience. Remember, ResusX is not a conference, it's the ultimate resuscitation experience.
ResusX:Reset Virtual
Virtual attendees can watch all the action, live from the comfort of their own home. And when the live attendees head off to the hands on workshops, virtual attendees will continue to watch their own exclusive lectures online. All virtual attendees will get access to the conference for 30 days after the conference is done!
UltraRounds Pre-Conference
Now is your chance to master point of care ultrasound for your critically-ill patients with UltraRounds. We will go over everything that you need to know about using ultrasound to resuscitate and monitor your patients. This one-day workshop is deeply immersive with a very heavy focus on bedside scanning so you leave ready to scan on your next shift.
Be Kareful, With Ketamine
Critical Care and Emergency Medicine loves ketamine for a variety of indications. One of the primary uses is for intubation due to it's hemodynamic stability. One misconception that I often see is that ketamine doesn't cause hypotension, even in sick patients...this is obviously untrue.
Watch this video on a deeper dive into why ketamine can cause hypotension and a strategy to avoid post-intubation hypotension. Check out the video for more information.
Managing Elevated ICP
In this YouTube video, Dr. Evie Marcolini discusses managing elevated intracranial pressure (ICP) in critical care and emergency medicine settings. She emphasizes the importance of preserving cerebral perfusion pressure (CPP) in brain injury or hemorrhage cases. The treatment follows a tiered approach, starting with a thorough assessment and simple interventions like head elevation, analgesia, and osmotic therapy with Mannitol or Hypertonic Saline. More invasive measures, such as vasoactive agents and paralytics, are considered in tier two, while tier three involves options like burst suppression with Phenobarbital or Craniectomy. Dr. Marcolini highlights the significance of understanding the underlying mechanism and choosing appropriate treatments to manage elevated ICP effectively. Watch the full video to learn more about the different treatment strategies and subscribe to the channel for more critical care and emergency medicine content.
Check out her amazing video now!
What's The Max Dose of Epi?
Salim Rezaie (@RebelEM) is a evidence-based master and this week I watched his video on the maximum dose of norepinephrine. He ran a poll asking the maximum dose allowed for NE and the results were interesting. You gotta watch the video, so no spoilers from me, but here are the takeaways.
Title: "Norepinephrine: How High Can You Go?"
1. **Research Findings**: Five studies were discussed, with the highest norepinephrine dose documented in research ranging from 1.4 to 2.91 micrograms per kilogram minute. Survival rates varied from 17% to 52%, and the duration of high doses ranged from 3 to 84 hours. Digit and limb necrosis rates were between 5.7% to 8%.
2. **Case Report**: A unique case reported a patient surviving with doses as high as 22 to 30 micrograms per kilogram minute for four hours after a blast injury.
3. **Assessment and Interventions**: If norepinephrine doses exceed 1 microgram per kilogram minute, it's crucial to assess causes. Recommendations include checking arterial line functionality, using ultrasound to assess ventricular functions, evaluating electrolytes, ensuring source control in sepsis, correcting acidosis, considering medication changes, and addressing adrenal insufficiency.
4. **Practical Application**: While there's no maximum dose, it's rare to need extremely high doses. In practice, if doses reach 0.2 to 0.3 micrograms per kilogram minute, it's advisable to start a second agent and assess underlying causes.
Click here for the entire video.
Watch All the Videos from Our Cardiac Arrest Conference!
ResusX:ROSC was a HUGE success with over 200 resuscitationists online live. But don't despair if you missed it....now is your chance to register for the conference and watch Amal Mattu, Scott Weingart, Corey Slovis, Tarlan, Hedayati, and so many more explore cutting edge techniques and literature for patients in cardiac arrest.
Now you can watch the entire two-day conference on replay while earning up to 7.0 AMA PRA Category 1Credit(s)TM . Watch the conference with the basic package or get the DeluXe package where you can watch the conference for one year, get a bonus video package with 25 of our top videos, and get a FREE t-shirt.
Whichever package you pick, you'll be ready to provide your next cardiac arrest patient with the most current and up to date management.
OMI vs. NOMI
Dr. Pendall Myers explains why the current STEMI paradigm for diagnosing heart attacks is flawed. He argues that STEMI criteria miss a significant number of patients with occluded arteries who need urgent treatment. Myers proposes replacing STEMI with a new paradigm called OMI (Occlusion Myocardial Infarction). OMI focuses on identifying coronary artery occlusions rather than just looking at ST segment changes on EKG. Research shows OMI criteria identify more patients with occlusions than STEMI, allowing earlier treatment and better outcomes. The cardiology community is starting to recognize issues with STEMI, as evidenced by new guidelines endorsing STEMI equivalents. Myers urges clinicians to start using OMI concepts now, improve EKG interpretation skills, and remember the goal of urgently treating occluded arteries.
Takeaways
- STEMI criteria miss 25% of patients with occluded arteries who need urgent treatment. These "STEMI-negative" Occlusion MIs have double the mortality.
- OMI focuses on finding coronary artery occlusions rather than just ST changes. Research shows it identifies occlusions better than STEMI.
- New cardiology guidelines endorse "STEMI equivalents" - accepting that STEMI criteria alone miss occlusions. This supports the OMI concept.
- Clinicians should start using OMI concepts now, before full adoption, to identify more patients who need urgent treatment.
- The ultimate goal is to urgently treat occluded arteries to save heart muscle and lives. STEMI distracts from this by focusing on EKG criteria.
Welcome To Chris' Corner
We're excited to announce a new section from contributor Chris Reilly. Chris is a guitar-swinging, song-singing, education-bringing physician from NYC. Follow him at @docreilles on Instagram and TikTok. Let's see what Chris has for us in his inaugural post.
A David & Goliath Story: Smaller Chest Tubes for Hemothorax by Chris Reilly, MD
Traditionally, the prevailing notion has been that larger-sized chest tubes (36-40 French) are necessary for effective blood drainage without clotting. Not so fast boomer! Studies have shown that smaller-sized tubes (28-32 French and even 14-French pigtail catheters) can be just as effective, if not more so, in managing hemothorax and pneumohemothorax cases. Research by Inaba et al. compared large and small tubes in hemothorax patients, revealing no significant differences in blood drainage, duration of tube placement, or complications. Similarly, Bauman et al. found 14-French pigtail catheters to be as effective as standard tubes. The P-CAT trial, a five-year multicenter study, further supports this shift to smaller tubes, showing comparable failure rates and improved patient experiences with pigtail catheters! Despite some limitations, the growing evidence suggests that smaller tubes could simplify management and enhance patient comfort, potentially leading to a new standard for hemothorax care.
Check out the full blog post by Dr. Zaf Qasim on Critical Care Now: https://criticalcarenow.com/trauma-chest-tubes-bigger-is-not-always-better/
Join the ResusNation and Get Tons of Content For Less Than a Cup of Coffee
Signup for the ResusNation today and see why over 500 resuscitationists are members. As a ResusNation member you will receive extra content from CriticalCareNow such as live digital teaching sessions, podcasts, free video lectures, a library of grand rounds, and so much more. Check out the memberships options available below and pick the one that is right for you.
There's nothing to think about, you'll be automatically billed monthly and cancel anytime....no questions asked! Looking for a deal? Pay for a yearly pass and get one month free!
ResusNation: Basic Membership (Monthly)
Show your support with our basic membership.
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Access to 2 cutting edge lectures monthly from world-renowned speakers every month
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Unlimited viewing of videos
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Ability to watch on a desktop or mobile video player
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Pay for a monthly or yearly membership
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CEUs available
ResusNation: All-Access Pass (Monthly)
The ULTIMATE membership! In addition to everything in the basic plan, you'll also receive:
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5 cutting-edge lectures monthly from world-renowned speakers
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Exclusive weekly podcasts
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Attend the exclusive Q & A session with Grand Round speakers
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Access our Grand Rounds library and watch previous episodes on replay.
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Watch every Chawk Tawk on replay
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Join our twice-monthly hangouts where you can hang out and ask us anything
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Access the ResusX Community, a forum for questions, post cases, & interact and network with others
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Receive CEU credits for the content that you watch
-
Pay for a monthly or yearly membership
ResusNation: Basic Membership (Yearly)
Show your support with our basic membership.
-
Pay for the year and get one month FREE!
-
Access to 2 cutting edge lectures monthly from world-renowned speakers every month
-
Unlimited viewing of videos
-
Ability to watch on a desktop or mobile video player
-
Pay for a monthly or yearly membership
-
CEUs available
ResusNation: All-Access Pass (Monthly)
The ULTIMATE membership! In addition to everything in the basic plan, you'll also receive:
-
Pay for the year and get one month FREE!
-
5 cutting-edge lectures monthly from world-renowned speakers
-
Exclusive weekly podcasts
-
Attend the exclusive Q & A session with Grand Round speakers
-
Access our Grand Rounds library and watch previous episodes on replay.
-
Watch every Chawk Tawk on replay
-
Join our twice-monthly hangouts where you can hang out and ask us anything
-
Access the ResusX Community, a forum for questions, post cases, & interact and network with others
-
Receive CEU credits for the content that you watch
-
Pay for a monthly or yearly membership
