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Critical Care Mailbag - Albumin in Resus, Aspiration in DSI, RSI Mistakes

Rob Orman, MD and Scott Weingart, MD
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EM:RAP January 2018 Written Summary 933 KB - PDF

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Po H. -

Hi Scott, Rob,

I had an interesting and stressful case with an status asthmaticus patient. She cam POV unresponsive and with sats 50 to 60%. We planed for DSI using ketamine and tried albuterol without much improvement. She rapidly received epinephrine and solumedrol. She was "guppy breathing" with small tidal volumes and we had to assist with some bagging.

Here is the problem: We had some difficulty with high airway pressures so I'm sure we insufflated the stomach by going over 20 cm water which did result in some emesis. Besides cricoid pressure, possibly magnesium, and slowing down ventilations to decrease breath stacking any other suggestions?

Seems like asthma is different than our other scenarios because of the high airway pressures and consequences of breath stacking.

Po Huang
Boise, Idaho

Robert A. A., M.D. -

I am confused about whether it is standard to practice after pushing meds in RSI. I have been taught to not bag (and it says in this section of EMRAP, to "pause" after pushing meds). This makes no sense to me. I generally always bag during the one minute I am waiting for the paralytic to kick in. Comments? Thank you for thoughts!

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The Collector Full episode audio for MD edition 263:02 min - 367 MB - M4AEM:RAP 2018 January German Edition Deutsche 96:14 min - 132 MB - MP3EM:RAP 2018 January Canadian Edition Canadian 18:24 min - 25 MB - MP3EM:RAP 2018 January Spanish Edition Español 94:31 min - 130 MB - MP3EM:RAP 2018 January French Edition Français 21:02 min - 29 MB - MP3EM:RAP 2018 January Individual MP3 340 MB - ZIPEM:RAP 2018 January Individual Written 964 KB - ZIPEM:RAP 2018 January Spanish Written 1,019 KB - PDFEMRAP Board Review Answers 2018 01 Jan Vol.18 01 95 KB - PDFEMRAP Board Review Questions 2018 01 Jan Vol.18 01 161 KB - PDFEM:RAP January 2018 Written Summary 933 KB - PDF

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