Ketamine model (WikiMedia)
One of my favorite conference speakers has always been Dr. Al Sacchetti from Camden, NJ, USA. He is passionate about Emergency Medicine and understands his patients. So when Dr. Sacchetti goes on a rant…I sit up and listen.
Who doesn’t love ketamine? It’s cheap and available worldwide. Use it for pediatric sedation, status epilepticus, and anesthesia. It can be administered intranasally, intramuscularly and intravenously.
But can it safely be used for agitated delirium? Listen to the October 2019 podcast or read the PDF: Rants from the Community: Ketamine by Al Sacchetti MD. It’s sure to calm your agitation when faced with a delirious patient.
Who Knew? Ketamine is a drug of abuse. When the drug is diverted for recreational use, the original pharmaceutical form is often abandoned. The most popular method is snorting ketamine powder. The powder is prepared by evaporation of the original solution or ketamine solution may be transferred to a vaporizer to be administered intranasally. As with all illegally sold drugs the concentration and presence of adulterants are mostly unknown and therefore represents a public health risk.
Photo from Wikimedia.
Most of us are anxious about taking care of infants and children younger than 2 years old who need airway support. It’s intimidating and challenging to face a small airway when most of us face this critical situation only a few times a year. It’s imperative to stay current and review the procedure and medications regularly. The September EM:RAP C3 podcast on Pediatric Airways hits all the vital landmarks for troubleshooting and management. Expertly presented by Jessica Mason MD, Mel Herbert MD, and Stuart Swadron MD, you will take home points such as; Infants and children have a much smaller pulmonary reserve than adults; thus they desaturate much more quickly after preoxygenation. More empowering take-home points await you so take a listen and share the knowledge.
Photo from Wikimedia.
Who Knew: Dr. Crawford Long administered the first documented ether anesthetic to an 8-year-old boy for a toe amputation on July 3, 1842.
The April edition of Right on Prime covers everything you need to know about congestive heart failure from the definition to palliative care, including advice on therapeutic phlebotomy. No matter where you practice you will find breath-taking take home points. Take a listen or read: The Generalist: Acute and End Stage CHF in the ED by Vanessa Cardy MD, Mel Herbert MD, and Heidi James MD in the April edition of Right on Prime available to all CMES participants using either the CMES thumb drive or Pi.
Leech application tubes and blood letting tool, probably from 1800s. Photo from Wikimedia.
Who Knew? Bloodletting (or blood-letting) is the withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, now called therapeutic phlebotomy, whether by a physician or by leeches, was based on an ancient system of medicine in which blood and other bodily fluids were regarded as “humours” that had to remain in proper balance to maintain health. It is claimed to have been the most common medical practice performed by surgeons from antiquity until the late 19th century, a span of almost 2,000 years. (article content from Wikipedia)
Airway Management is just that…managing the airway upside down and inside out. Take a quick read of the PDF or listen to EM:RAP’s November MP3 audio podcast called Strayerisms: Fluid Filled Airway. It’ll float your boat.
Correct ET tube placement, but if you tube the esophagus, leave the ET tube in place and use it as a landmark.
According to Dr. Reuben Strayer MD, the author, there are four ways to harm your patient during airway management: failure to oxygenate; failure to ventilate; worsening perfusion; and aspiration. His suggestions are doable no matter where you practice or what resources you lack…remember…your greatest resource is knowledge.
Who Knew? Probably the oldest recovered boat in the world, the Pesse canoe, found in the Netherlands, is a dugout made from the hollowed tree trunk of a Pinus sylvestris that was constructed somewhere between 8200 and 7600 BC. This canoe is exhibited in the Drents Museum in Assen, Netherlands. (Not looking too seaworthy these days.)
Twenty years ago I was a volunteer at a small rural hospital. A trauma patient was on the way in and I asked the nurse to prime two IV bags, open the BVM and ETT. She declined and said their policy was not to open supplies until at bedside. I get it…supplies are a resource not to be wasted…but having a dedicated airway kit prepped and ready at the bedside is crucial to RSI success.
The crash airway mnemonic SOAP ME runs down the list of everything you need for a successful Rapid Sequence Intubation (RSI) in the crashing airway patient. EM:RAP’s September podcast of Critical Care Mailbag: The Crash Checklist by Anand Swaminathan MD and Scott Weingart MD should be on everyone listening list.
Review what the mnemonic SOAP ME checklist stands for; how to temporize the crashing airway; how to treat the obstructed airway; and most importantly…tips on how to be ready for any airway headed for a crash and burn.
Heres a quick reference for SOAP ME. What’s in your kit? Leave a comment and start the dialogue.
Photo courtesy of Wikimedia Commons.
Who Knew? William Macewan (1848-1924), a Glasgow surgeon, invented a type of endotracheal tube pictured. He was the first person to use an endotracheal tube to give a patient anaesthetic, in 1878. A tube was placed in the larynx to give the patient a dose of chloroform. These examples are made from steel and brass. They range in length from 210 mm to 80 mm for patients of all sizes.