Maycol Franco

EM consultant based in Italy, ex resident at @UniPd_EM, airway management and trauma care passionate, tennis racket in my hands and hiking shoes on my feet

[Stephen King @StephenKing]

ICE is the American Gestapo.

[Maycol Franco @FrancoMaycol]

#ios26 the worst update ever #apple #iOS26update

[Maycol Franco @FrancoMaycol]

Break the selective silence on the genocide in Gaza - The Lancet https://t.co/xXTjCmdgDG
#Gaza #israel

[Maurizio 5 stelle @BracaliM]

#Meloni sei complice dell'assassino #Netanyahu, però consolati nelle famose democrazie occidentali non sei sola. #governodellavergogna #GazaStarving #GazaGenocide‌ #IsraelTerroristState #Netanyahu_A_criminal_of_war

[Maycol Franco @FrancoMaycol]

Find the difference #IsraelTerroristState

[Suzana Dornelles @sudornelles]

Nethanyahu é Hitler

[Maycol Franco @FrancoMaycol]

It’s for person like @SecRubio that I will leave X. Well done @EmmanuelMacron

[Secretary Marco Rubio @SecRubio]

The United States strongly rejects @EmmanuelMacron’s plan to recognize a Palestinian state at the @UN general assembly.

This reckless decision only serves Hamas propaganda and sets back peace. It is a slap in the face to the victims of October 7th.

[Maycol Franco @FrancoMaycol]

Stop Israel’s genocide NOW
https://t.co/0G8fGOidi2

[Ross Prager @ross_prager]

(5/x) Be generous with with vasoactive medications peri-intubation, and remember, most arrests happen 5-10minutes after induction NOT immediately.

Don't celebrate too early.

[Maycol Franco @FrancoMaycol]

Brilliant

[reuben strayer @emupdates]

How I see patients in the emergency department, after 20 years of seeing patients in the emergency department.

https://t.co/9SZCp6By56

[Maycol Franco @FrancoMaycol]

@giovX3 @simone_ghrd 🤡

[Maycol Franco @FrancoMaycol]

🚨🚨🚨

[Journal of Trauma and Acute Care Surgery @JTraumAcuteSurg]

❇️Best of Trauma❇️

Clinical decision algorithm for adult emergency resuscitative thoracotomy incorporating current available research and expert opinion from the Western Trauma Association.

https://t.co/ZdKY18MD0T

[Maycol Franco @FrancoMaycol]

Chest pain. Do not trust computer based ekg interpretation ⚠️ (unless you’re using @PMcardioApp)

[Maycol Franco @FrancoMaycol]

@giovX3 Grande sei 💪🏼

[ParamedProf is at paramedprof.bsky.social @ParamedProf]

Presented without comment. #OHCA #ROSC
https://t.co/GOS5XSwRHO

[Luca Carenzo @carenzmd]

Contemporary management of traumatic cardiac arrest and peri-arrest states: the most up-to-date narrative review. Written with @ewoudterAvest @ZBPerkins @LorenzoGamberi6 @ResusOne Marius Rehn Giulio Calgaro. Available for free on @jaacc_online: https://t.co/kl7DduzxvY

[Salim R. Rezaie, MD @srrezaie]

Intubation Microskills

-Laryngoscopy: How you hold the laryngoscope
-Epiglottoscopy: Incrementalizing finding structures
-Valleculoscopy: Engaging with structures

#intubation #FOAMed #FOAMcc

[𝗥𝗲𝘀𝘂𝘀𝗠𝗲𝗱 @ResusMed]

Mechanical ventilation during CPR: six-dial strategy

The "Six-dial Strategy" is an evidence-based approach to set mechanical ventilation parameters during CPR when an advanced airway is in place. The current guidelines indicate that positive pressure ventilation (PPV) should be provided without interrupting chest compressions. Mechanical ventilation (MV) can be advantageous over bag-valve ventilation (BV) in busy emergency settings with limited trained personnel as it reduces human error and allows the airway manager to focus on other critical resuscitation tasks.

Six-dial Ventilation Strategy:
Positive End-Expiratory Pressure (PEEP) = 0 cm H2O:
The rationale is to avoid impeding venous return during chest recoil. Although PEEP can improve oxygenation by recruiting collapsed alveoli, it also increases intrathoracic pressure, potentially reducing venous return and thus cardiac output during CPR. The recommendation of zero PEEP is primarily based on the theoretical benefit of not impairing venous return, with limited direct evidence from human studies.

Tidal Volume = 8 mL/kg and Fraction of Inspired Oxygen (FiO2) = 100%:
This setting aims to match the recommended tidal volume of 600 mL for adults during cardiac arrest, with the goal of minimizing ventilation-perfusion mismatch caused by CPR. The use of 100% FiO2 is to ensure maximal oxygen delivery during the resuscitation period, as higher arterial oxygen levels during CPR have been associated with better outcomes.

Respiratory Rate = 10 breaths per minute:
The recommendation is to prevent hyperventilation, which is common during CPR and can increase intrathoracic pressure, reducing venous return and cardiac output. A respiratory rate of 10 breaths per minute is seen as adequate to maintain normal ventilation-perfusion ratios during the low cardiac output state induced by chest compressions.

Maximum Peak Inspiratory Pressure (Pmax Alarm) = 60 cm H2O:
Given that chest compressions can increase intrathoracic pressure significantly, the Pmax alarm is set higher (60 cm H2O) to ensure that the ventilator delivers the set tidal volume even if inspiratory breaths coincide with chest compressions. There is a cautionary note about the risk of barotrauma, so Pmax settings should be tailored individually, not exceeding 80 cm H2O.

Ventilator Trigger = OFF:
Trigger settings are turned off to prevent the ventilator from being falsely triggered by chest recoil, which can lead to hyperventilation and impaired gas exchange during CPR. If the ventilator does not allow the trigger to be completely disabled, a high trigger threshold (e.g., -20 cm H2O) is recommended to minimize inappropriate triggering.

Inspiratory Time = 1 second (I ratio of 1:5):
The strategy maintains an inspiratory time of 1 second to align with standard recommendations for breath duration during CPR. With a respiratory rate of 10 breaths per minute, this corresponds to an inspiratory-to-expiratory ratio of 1:5, allowing sufficient time for exhalation and maintaining low intrathoracic pressure.
Limitations:

Conclusion:
The article emphasizes that while MV can offer significant benefits over BV, there are associated risks, including barotrauma, lack of mechanical ventilators, and the need for specialized expertise. Moreover, once ROSC is achieved, ventilator settings should be adjusted from the "Six-dial" strategy to post-ROSC settings that focus on lung-protective strategies and normocapnia.

Overall, this approach provides a structured method for ventilator management during CPR, addressing the lack of specific guidelines and aiming to optimize patient outcomes through evidence-aligned ventilator settings.

https://t.co/PIivtAPnJc

[Maycol Franco @FrancoMaycol]

Next resuscitation guidelines will focus more on ventilation ✅
Future resuscitation guidelines may implement CCSV ⚠️

[Critical Care Reviews @CritCareReviews]

Airway management and ventilation techniques in resuscitation during advanced life support: an update

CCR Journal Watch
https://t.co/Sp06oA6IDG

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