October Introduction

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Nurses Edition Commentary

Mizuho Spangler, DO, Kathy Garvin, RN, and Lisa Chavez, RN
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Stephen T. -

Great piece regarding foley associated UTI. A few questions regarding suprapubic catheters... 1) What is the best way to obtain a urine sample 2) Should we treat a suprapubic cath the same as a foley and replace it if it's been in longer than 2 weeks to obtain clean urine 3) When should we not be touching/removing a suprapubic cath 4) Any general pearls to know regarding suprapubic catheters

Thanks!

Dharmesh S. -

In the vent talk, Swami says ACMV can cause metabolic alkalosis in patients who drive the vent at a high rate - he probably meant respiratory alkalosis.

Jean-Francois S. -

Hi,
I just listened to Ventilator 101 talk. I have a few comments.
1. SIMV is not a good ventilator mode (with or without pressure support). It has been shown in the literature to be responsible of more ventilator-patient dyssynchrony. This mode was develop for weaning and showed prolonged weaning... There is not utility in modern ICU for this mode, except maybe for intractable hiccups.
2. If you intubate a patient with a severe obstructive disease and are preoccupied with the possibility of breath stacking and majoring the auto-peep, stay in AC mode and sedate/paralyse the patient to take full control. I don't think that SIMV will help you.
3. Tough PC is probably suitable for ARDS patients, the most evidence favour a VC approach aiming for 6cc/kg. This is the best evidence we have for ventilator strategy fro ARDS patient and I think we should stick to it.

I am more than open to discussion/contre-agumentation

Jeff

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Vents, Scabies, and IV Fluid Cage Match Full episode audio for MD edition 256:28 min - 357 MB - M4AEM:RAP 2015 Octobre Résumé en Francais Français 65:06 min - 39 MB - MP3EM:RAP 2015 October Aussie Edition Australian 31:30 min - 43 MB - MP3EM:RAP 2015 Octubre Español 71:43 min - 38 MB - MP3EM:RAP 2015 October Canadian Edition Canadian 20:46 min - 16 MB - MP3EM:RAP 2015 Español Octubre 2015 1 MB - PDFEM:RAP 2015 October Board Review Answers 243 KB - PDFEM:RAP 2015 October Board Review Questions 343 KB - PDFEM:RAP 2015 October MP3 253 MB - ZIPEM:RAP 2015 October Summary 928 KB - PDF