Gaining control of the airway in a critically unwell patient is a key skill of the critical care team and littered with potential for difficulty and complications.
NAP4 highlighted the real dangers faced with their review of complications of airway management in the UK, lessons have been learnt and practice has progressed. As always there is room to improve on current practice and a recent paper published in Anaesthesia describes a comprehensive strategy to optimise oxygenation, airway management, and tracheal intubation in critically ill patients in all hospital locations.
In this podcast we cover;
We'd love to hear your thoughts so please leave your comments below or contact us via twitter @TheResusRoom
Enjoy!
References & Further Reading
How often do you prescribe or give i.v. fluids to your patients? How much thought goes into what's contained in that fluid? What effect will you fluid choice have on your patient?
Two trials on crystalloid administration in the acutely unwell patient have occupied a lot of conversation in the research world over the last few weeks, both published in the NEJM and in this podcast we take a look at them.
In the podcast we cover the following;
Make sure you take a look at the papers yourself and come up with your own conclusions. There are a whole host of superb FOAM resources out there on the topic that are well worth a look and referenced below.
We'd love to hear any thoughts and comments below.
Enjoy!
References & Further Reading
| Fluid | Na | K | Cl | Ca | Mg | Lact | Acet | Glucon | Dext | Osmol mOsm/L |
| 0.9% N Saline | 154 | 0 | 154 | 0 | 0 | 0 | 0 | 0 | 0 | 308 |
| Lactated Ringers | 131 | 5 | 11 | 2.7 | 0 | 29 | 0 | 0 | 0 | 273 |
| Hartmanns | 129 | 5 | 109 | 4 | 0 | 29 | 0 | 0 | 0 | 278 |
| Plasma Lyte | 140 | 5 | 98 | 0 | 3 | 0 | 27 | 23 | 0 | 280 |
Constituents measured in mEq/L Reference; University Texas
Balanced Crystalloids versus Saline in Critically Ill Adults. Semler MW. N Engl J Med. 2018
Balanced Crystalloids versus Saline in Noncritically Ill Adults. Self WH. N Engl J Med. 2018
Patient-Centered Outcomes and Resuscitation Fluids. Myburgh J. N Engl J Med. 2018
REBEL.EM; Is the Great Debate Between Balanced vs Unbalanced Crystalloids Finally Over?
PulmCrit- Get SMART: Nine reasons to quit using normal saline for resuscitation
JC: Balanced fluids vs Saline on the ICU. The SMART trial. St Emlyn’s
Welcome to March's papers of the month. We know we're biased but we've got 3 more superb papers for you this month!
First up we review a paper looking at oxygen levels in patient's with a return of spontaneous circulation following cardiac arrest, is hyperoxia bad news for this patient cohort as well as the other areas we've recently covered?
Secondly we have a look at a paper reviewing the association between time to i.v. furosemide and outcomes in patients presenting with acute heart failure, you may want to have a listen to our previous podcast on the topic first here.
Lastly, when you see a pregnant patient with a suspected thromboembolic event, can you use a negative d-dimer result to rule out the possibility? We review a recent paper looking at biomarker and specifically d-dimers ability to do this.
We'd love to hear from you with any thoughts or feedback you have on the podcast. And we've now launched of Critical Appraisal Lowdown course, so if you want to gain some more skills in critical appraisal make sure you go and check out our online course here.
Enjoy!
MDCALC; Framingham Heart Failure Diagnostic Criteria