JM Riphagen

You always try to use the minimum amount of O2 in general and especially in premies, as it is bad for surfactants in the premature lung , that has been like that since I can remember. Hypoxia isn’t great either and will also give stress. ICU is an exercise in dynamic compromise management.

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The Locus Coeruleus Noradrenaline System in Delirium Delirium is a brain state involving severe brain dysfunction affecting cognitive and attentional capacities. Our opinion statement review aims to elucidate the relationship between abnormal arousal an...

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Well dex is pretty selective for Locus Coeruleus and that is probably dysregulated in delirium states. However I think that there area few flavors of delirium that look clinical similar which account for the heterogeneity response. Some react great to a whiff of clonidine/dex, others don’t

I’m not advocating it as a standard but It works perfectly well if a little judgement is used.

You can just test it. Induce do not relax. Test if pt reacts to blade and tube (the solution is not roc as a 1st thought). Deepen. If nothing happens but cords are meh, relax. But you don’t need much to relax the cords (the laryngeal muscles are last to come back for a reason). 1/2

I rather have a bunch of 14G’s. However, older people that learned both forget that some folks are now trained to be 100% tech dependent. Only did camera double lumen, can’t intubate a MP 2.5 without a VL. CVL without US 😱. If your GPS dies you still need to be able to do map and compass imho.

Ah the ol’ squatting (asian genes help😋) in questionable bodily fluid day. 🎉 We never got the mac 4 VL blades which a shame. I was switched to 4’s when I moved countries.

If you would want to write an algorithm you can take the peaks with adequate SNR then fit an envelope to extrapolate the systolic and diastolic. If you look at the data from the paper I posted with actual measurements in a real world environment what do you see?

There is a calibration setting on the nibp for that fwiw.

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No it shouldn’t take 5 years (can’t say that it ever took more than a year) www.nature.com/articles/d41...

Non-invasive versus arterial pressure monitoring in the pre-hospital critical care environment: a paired comparison of concurrently recorded measurements - Scandinavian Journal of Trauma, Resuscitatio... Background Blood pressure monitoring is important in the pre-hospital management of critically ill patients. Non-invasive blood pressure (NIBP) measurements are commonly used but the accuracy of stand...

sjtrem.biomedcentral.com/articles/10..... Based on this NIBP vs Art data can be wildly off , however the diastolic measurements have a systematic error while systolic and MAP either underestimates or overestimates. I think the important thing this is to be aware and not view anything in isolation.

When is the last time you read print ?

Low diastolic pressure means lower coronary perfusion, especially in a tachycardia setting , especially when there are stenoses present. Also there are a range of systolic and diastolic pressures with the same MAP.

Given that arithmetically diastolic pressure is 2/3 of MAP this is an interesting statement.

They definitely do use TIVA. They don’t use low flow sevo which is weird to me.

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I preferably wouldn’t do a spinal regardless of the clopidogrel for #NOF . These cases can go quick (45 minutes door to door) or end up as a 4 hour epos with cerclage and indecent blood loss. I don’t see the upside for the patient.

You did OB right 🤔? Things get that bad in zero seconds. A dose of pressor costs €2, if you don’t use it it goes to the next case. Same with propofol. Waste at the end of a program is negligible on the scale of things. If you want less waste get 2% propofol for TIVA cases.

None of the places I worked at especially ICU had one readily available (maybe in a closet somewhere). It should just be on the intubation cart.

I don’t see why capno is that useful beyond what a pulse ox does for this purpose. Also 🙌 and 👁️. You have to check wounds/drains etc under the blanket anyway. You do need one available for intubation. #MedSkyDebate

Maybe look at AQP4/Area Postrema literature.

Normal GA. Decent IV,Remi & titrate Propofol very very slow. Sevo on minimal flow. I would put in an art line and 2nd iv after induction.

Concur. Done enough as well . When using a fibre it’s mostly unnecessary to do it fully awake and you can do it with spontaneous breathing under sedation. Yes there are some edge cases where fully awake would be a better choice but those cases need an experienced specialist team approach anyway.

🤦. That’s the first one .

Just like real estate has the 3L’s : location location and location, anesthesia has the 127 P’s and they are all Position: Your position, the patients, the environment, the equipments’, the probes’, the needles’ etc etc 😉.

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I would suggest using two clock faces one vertical and one horizontal for communication . My preference following the curve of the tube and to drop tube to 2:15 /3:15. You can rotate and alter the tip pitch in zero space. Yaw you rarely need much.

If you have your helper pull down the cheeck/mouth and come in 3h horizontal and 2h vertical you can rotate the tip (which is beneficial for mac but also HAVL) and you don’t block your sight line. Impossible on a mannequin. I think a low fi but geometry correct model is much more useful.