The Educational Newsletter From  CriticalCareNow!

Never Take Your Foot Off the Gas During Resuscitation

Cliff Reid (@CliffReid) is a renowned resuscitationist and highlights a critical aspect of managing high-stress resuscitation scenarios. He describes how, after successfully intubating a patient and achieving initial stability, there tends to be a collective sense of relief in the room. This momentary relaxation can lead to a lapse in vigilance as team members engage in banter, review ultrasound images, or discuss unrelated topics. Reid emphasizes the importance of maintaining situational awareness, as resuscitation rooms have a natural tendency to transition from order to disorder, akin to the concept of entropy in thermodynamics. To counter this trend, it requires continuous effort and focus to prevent or reverse the chaos that can ensue, especially as fatigue sets in during a resuscitation.

Cliff Reid's insight underscores the need for resuscitation teams to remain alert and cohesive throughout the entire process, recognizing that the initial success of intubation should not lead to complacency. It's a reminder that managing chaos in a resuscitation room is an ongoing, active process that demands unwavering attention to detail and teamwork to ensure the best possible outcomes for critically ill patients.

Chris Reilly is a guitar-swinging, song-singing, education-bringing physician from NYC. Follow at @docreilles on Instagram and TikTok. Let's see what Chris has for us this week.

One of the Most Common Arrhythmias You’ll See

No, we aren’t talking about Afib. Sinus Tachycardia. Yes, it may seem obvious but, I don’t think we talk about it enough. It never gets the love and respect it deserves. Orthodromic Supraventricular Tachycardia sounds super sexy but is way less common than our friend here, Sinus Tach. 

Sinus Tachycardia is primarily triggered by physiological, pharmacological, or neuropsychological disturbances. It serves as an early indicator of internal distress that requires thorough investigation. Why is your patient’s heart rate elevated? Is he/she trying to compensate for something else bad going on? Remember, cardiac output needs to be maintained, so if your patient’s heart rate is up, maybe the stroke volume is down? Or maybe you can think back to the oxygen delivery equation to help find your answer. In our critically ill patients, I’d like for you to put an emphasis on those determinants: cardiac output, arterial oxygen content (hemoglobin bound), and dissolved oxygen in the blood. 

Febrile states, medication interactions, withdrawal effects, and metabolic/hormonal imbalances can also induce sinus tachycardia, emphasizing, once again, the need to search for the underlying cause. One of the most common presentations of sinus tachycardia we can see in the Emergency Department and ICU is from pain or anxiety. Is your intubated patient tachycardic because the fentanyl ran out? Keep in mind, these neuropsychiatric etiologies are diagnoses of exclusion! Please don’t treat the sinus tachycardia or afib with RVR with medications first. If you take away the tachycardia, their normal compensatory mechanism, you may tank your patient! 

Bottom line: when you see sinus tachycardia on the monitor, make sure you investigate the underlying cause, don’t just treat the number. 

Check out the full article by Obiajulu Anozie.