Intraosseous (IO) access is a quick, relatively inexpensive, and simple route for obtaining “central” access in trauma and resuscitation settings when peripheral access is difficult to acquire. When placing an IO line, care must be taken to avoid fractured bones, active infections, and patients with underlying bone pathology like osteopetrosis.…
The lethal diamond in trauma – acidosis, hypothermia, hypocalcemia, and coagulopathy – defines much of what I do in the ICU and cardiothoracic ORs. It’s important to appreciate the interplay between these three derangements, anticipate problems, and intervene quickly.
Blakemore tubes (and their analogues like Minnesota tubes) are rarely used in the modern day of endoscopy but can still have a role in the acute setting of GI variceal bleeding. These tubes are lubricated and passed to roughly 50 centimeters in the same manner as an orogastric or nasogastric…
Prevention of hypoxemia requires a protected, unobstructed airway and adequate ventilation which takes priority over managing all other conditions.
As of yesterday, I’m officially certified in Advanced Trauma Life Support (ATLS) for the next four years! This two day course was required and paid for by my critical care fellowship, so I wanted to summarize some of the pearls I learned.
The indications for central venous catheters (CVCs) include invasive hemodynamic monitoring, transvenous cardiac pacing, hemodialysis, lack of peripheral venous access, administration of vasopressors, nutritional support, and in some texts…. volume resuscitation. It’s this last one that bothers me. Yes, some CVCs like multi-lumen access catheters (MAC) can be wonderful for massive resuscitation,…
Trauma anesthesia is a whole different game – you never know what could roll through the door at a moment’s notice. Some patients are innocent victims of car accidents, crossfire, or simply being in the wrong place at the wrong time. Others were injured while engaging in criminal activity. As…