Emrap critical care edition

Is there risk in providing some supplemental oxygen while you work on improving perfusion? Good question. I would definitely give supplemental O2 but put more of your focus on improving perfusion. If you have to, can get an ABG for oxygenation but, wouldn't be my priority. September Introduction. Rural Medicine: Treat the Labs or the Patient.

Free Audio. Critical Care Mailbag: Perfusion Index. Myasthenia Gravis P1. The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

In the sedation of the COPD patient, does your sedation change if the patient is very hard to ventilate? Is this a case where you'd consider a ketamine infusion until the COPD is better controlled and the vent settings come into a tolerable range, and then switch over to a more traditional fentanyl and propofol sedation package?

I am unimpressed with the bronchodilatory power of ketamine and would not choose it preferentially over propofol which also has bronchodilatory properties, albeit prob. Question in regard to post intubation sedation for bleeding trauma patients that require transfer. Is there any concern for sending these patients out on a ketamine drip, or frequent ketamine dosing? Often these patients are very tachycardic, and I'm wondering if it would put these patients at increased risk for catecholamine surge and heart failure.

Would dex be a better option in this scenario? We often hear concerns about tachycardia and hypertension with ketamine but in the sick patient, they're likely unfounded worries. Ketamine leads to endogenous catecholamine release but in sick patients trauma or otherwise the patient has likely used up all their catecholamines already or has maximal surge already from the illness. Ketamine is unlikely to change this. The problem I see with dex is that it needs time to take effect and titrate which you're unlikely to want to take when you're transferring for definitive care.

Many prehospital systems and systems with long transport times rely on ketamine for this indication. I'll forward along to Scott as well and see his thoughts. You mention using pressors like norepi when dealing with post-intubation hypotension whether that's from the intubation itself, or the patient's underlying pathological process.

Pediatric Pearls: Neonatal Rashes. EM Executives Part 2. August Mailbag. August Mega Summary. Sign in or subscribe to listen. No me gusta! Sign up today for full access to all episodes. Mary C. Bradley L.