The potential for harm makes this a topic that needs to be followed in the coming years
If you’ve spent the entire year viewing CNN’s coverage of Trump, here’s a quick catch up of the year in Critical Care.
The main points:
Restrictive blood transfusion still rules. Fresh blood is no better. Antibiotics are time critical in sepsis.
No oxygen for MIs – unless hypoxic. Routine recruitment maneuvers in ARDS not indicated.
Acetylcysteine and bicarbonate for contrast angiography in high renal risk not helpful.
ICU routine admission for over 75 year old not always necessary.
Individual systolic BP targeting with Norepinephrine reduces organ dysfunction.
Angiotensin II may be next therapy for vasodilatory shock.
You’re welcome. Now back to CNN! Or read the summaries and links at thebottomline.org
Unfamiliar environments, inadequate equipment and protocol deviation all contribute to a higher risk in airway management outside the OR. The full range of support devices, like supraglottic airways, videolaryngoscopy and cricothyrotomy devices must be available as in the OR. And dark X-ray departments are even scarier!
Of interest they note the use of nasal cannula oxygen under your pre-oxygenation mask increased to 15l/min during intubation attempts as shown effective in other recent studies. And the continuing debate on the effectiveness of cricoid pressure, releasing if it impedes the procedure
Yet another article on the dangers of the past practice of excessive fluids in abdominal surgery to fill the imaginary and dated concept of “third space”. How to tailor this and avoid hypovolemia remains to be optimized but some ideas include pulse (or systolic) pressure variation or inferior vena cava diameter variation with respiration.
Maybe colloids are fighting back
But however, a more draconian advisory from Europe on “banning” hydroxyethyl starches that may not apply to those not critically ill EMA statement
Anaesthesia Journal on the renal complications of anesthesia. Risk factors include acute surgery, sepsis, age, anemia, diabetes, hypertension, vascular disease, cardiac failure, hepatic disease, pre-existing renal disease, trauma, abdominal hypertension, nephrotoxic drugs.
Small increases in Creatinine can have dramatic impacts on mortality.
A review of risk and management strategies
Substance abuse is quite prevalent – cannabis, cocaine, opioids, hallucinogens, ecstasy, amphetamines. Inform yourself in this outline in the Canadian Journal of Anesthesia
So the jury is back and we must all prepare a Phenylephrine syringe pump to commence on inserting the spinal in OB
We may see more of Norepinephrine in the future – about 8mcg seems the equivalent of 100mcg Phenylephrine, without the bradycardia link