@IM_Crit_ This is actually the issue. Mean airway pressures are major determinants of oxygenation.ApRV creates high mean airway pressures with Phi. The uninformed think it is magic. Just turn up the PEEP. Both are ways to increase lung volumes
@kdsvector@csports1995@IM_Crit_ Complete agreement regarding pushes although can turn NE up to ~0.8 mcg/kg/min —essentially a bolus. If this much shock, contractility likely impaired. Prefer epi>AVP despite heart rate. Studies show epi 10-30 mcg no more SVT than phenyl
@kdsvector@IM_Crit_ Good thoughts time permitting, but may not have time. Turn ne WAY up. Consider capnography or continuous hand on pulse to
Assess circulation. Push dose epi (commercially available) 10-30mcg.
@Rick_Pescatore Can help identify physiology in complex patients. Normal capnograph= NOT COPD exacerbation. Upsloping linear phase III = mechanical obstruction. think it is useful in asthma. Downsloping phase III- ? Pneumothorax.
@Rick_Pescatore Agree capnography is not helpful universally, or even usually. But the waveform is still helpful in a non-trivial amount of patients. We turn the alarms down quite a bit (~10) to avoid nuisance alarms, still detects unrecognized vent disconnect.
@emily_fri@gretchemaben Data suggest 1) one must have ~50 intubations to have a 90% success intubating easy, stable airway; 2) severe complications occur in 25-45% of ICU intubations. So, yes inexperienced fellows must be supervised (not necessarily by attending).
@nursekelsey EXCEPT re-tying wrist restraints on an icu patient. Instead, immediately notify the nurse that you untied them. The nurse WILL re-tie better than you.
@critconcepts@pulmtoilet Even with low positive pressure trans pulmonary pressure may be elevated, leading to global and/or regional overdistension (pendeluft)
@emily_fri How is Resp alkalosis harmful? Resp alkalosis balances the increased Resp drive from pain, low Vt, inflammation, many others. A little alkalosis decreases Resp drive and improves vent synchrony, decreases need for sedation.