Vasopressor Basic Flow Chart - Emcrit 2014 #Vasopressor #Basics #FlowChart #Algorithm #Management #CriticalCare

Basics of Mechanical Ventilation M. Daniyal Hashmi, MD @MDaniyalHashmi1 #Ventilator #Modes #Ventilation #CriticalCare #Management #Mechanical #Basics

Swan Ganz - Pulmonary Artery Catheter Basics Nick Mark MD @nickmmark #PA #SwanGanz #Pulmonary #Artery #Catheter #Basics #Diagnosis #Management #CriticalCare #ICU #pressures

Mechanical Ventilation: The Basics In the most basic sense, ventilator modes are defined by their control variable and settings. Breaths are triggered (started) and cycled (ended) by specific parameters, which are determined by the mode. While there are many modes to choose from, we will review the most basic below. Assist Control / Volume Control (AC/VC): • Delivers mandatory breaths at a fixed rate with a set volume (control) and allows spontaneous breaths to be triggered, but will assist those breaths with the full set volume as well (assist). • Volume Cycled, Delivers volume until set volume goal is reached • Volume: 6-8 cc/kg IBW, RR: depends on pt/scenario, PEEP: ARDSnet PEEP ladder, FiO2: goal spO2 > 88% Assist Control / Pressure Control (AC/PC): • Delivers mandatory breaths at a fixed rate with a set pressure for a set inspiratory time (control) and allows spontaneous breaths to be triggered, but will assist those breaths with the full set pressure and i-time as well (assist). • Time Cycled, Delivers set pressure for set inspiratory time (i-time) • PC: adjust to achieve Vte, RR: depends on pt/scenario, PEEP: ARDSnet PEEP ladder, FiO2: goal spO2 > 88% Pressure Support Ventilation (PSV): • Often, a "weaning" mode. Unlike in AC modes, in PSV all breaths are spontaneous with pressure to support the breath, but not "control" it (no mandated volume or i-time). • Flow Cycled, Delivers pressure support until flow has reached 25% of its peak • PS: 0-8, if in an SBT, RR: spontaneous, PEEP: 5-8, FiO2: goal spO2 > 88% Dr. Meredith Greer @EmmGeezee #MechanicalVentilation #Basics #Modes #Comparison #management #criticalcare

CORNEAL ABRASION MANAGEMENT FLOW CHART. #Management #Ophthalmology #Corneal #Abrasions #Algorithm

Extracorporeal Membrane Oxygenation (ECMO) - Basics Mode of cardiopulmonary support used to treat pulmonary and/or cardiovascular failure with an external artificial circuit ECMO GOALS: • Maintain adequate tissue oxygenation to allow recovery from potentially reversible cardiopulmonary failure • Adjust ventilator settings with very low tidal volumes, allowing for lung rest, minimizing further ventilator-induced lung injury • ECMO is a bridge, not a destination Veno-Arterial (VA) • Supports heart and lungs (complete cardiopulmonary support) • Blood drains - venous system • Blood returns - arterial system Veno-Venous (VV) • Suppots lungs (pulmonary support only) • Blood drains - venous system • Blood returns - venous system E-CPR • Rapid deployment of VA-ECMO when CPR is unsuccessful in achieving sustained return of spontaneous circulation PARAMETERS Flow (mL/kg/min): • Dial in RPMs and flow depends on resistance in patient & circuit • Generally set between 4-6 Lmin (100-150 mL/kg/min in children) • On VA-ECMO - flow supports cardiac output • On VV-ECMO - flow supports oxygenation Sweep (L/min): Sweep gas flow determines PCO2 clearance (ie, ventilation) for both VV- & VA-ECMO OXYGEN DELIVERY • From both lungs & oxygenator • Assess perfusion (eg, NIRS, SVO2, lactate) REST SETTINGS • If ventilated, frequently placed on low "rest" settings with moderate PEEP • Bronchoscopy may be needed for plugging ANTICOAGULATION • To reduce risk of thromboembolism in circuit • Done per institutional protocol ELECTROLYTE REPLACEMENT • Particularly Ca+ due to citrate binding #Extracorporeal #Membrane #Oxygenation #ECMO #Basics #management #pulmonary #criticalcare

Priority-based management algorithm for the undifferentiated patient in PEA arrest PEA (no pulse by manual palp + organized non-shockable rhythm) 1. Start chest compressions 2. Cardiac POCUS 3. Start femoral A-line placement - POCUS pulse check 4. Start vasopressor infusion / Push-dose vasopressors - Dr. Bo Zheng & Dr. Alex Coutin #PEA #arrest #algorithm #pulseless #electrical #activity #management #criticalcare

Vasopressors Demystified Shock comes in many flavors and so do vasopressors. Here’s a OnePager summarizing my approach to pressors including when to start, which ones to use, how to administer them, and when to increase or wean. Includes my favorite pressor pedagogical device: the pressor-speedometer. Nick Mark MD @nickmmark #Vasopressors #Basics #CriticalCare #Management #Pharmacology #Comparison #Inotropes

Tailoring Vasopressors to a Patient's Physiology Overall, norepinephrine, epinephrine, and vasopressin are all supported by evidence as potential first-line vasopressors. There is no proof that any is superior to any other. It's possible that the best drug might depend on an individual's physiology #Management #CriticalCare #Vasopressor #Selection #Algorithm #FirstLine #Sepsis

Difficult Airway Algorithm 1. Assess the likelihood and clinical impact of basic management problems: • Difficulty with patient cooperation or consent • Difficult mask ventilation • Difficult supraglottic airway placement • Difficult laryngoscopy • Difficult intubation • Difficult surgical airway access 2. Actively pursue opportunities to deliver supplemental oxygen throughout the process of difficult airway management. 3. Consider the relative merits and feasibility of basic management choices: • Awake intubation vs. intubation after induction of general anesthesia • Non-invasive technique vs. invasive techniques for the initial approach to intubation • Video-assisted laryngoscopy as an initial approach to intubation • Preservation vs. ablation of spontaneous ventilation 4. Develop primary and alternative strategies #Difficult #airway #algorithm #Anesthesiology #Anesthesia #CriticalCare #Management

Massive Hemoptysis - Management Algorithm #Massive #Hemoptysis #Management #Algorithm #Pulmonary #CriticalCare