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The other big issue is hypernatremia (and/or metabolic alkalosis). As I recall, that was the main reason it was abandoned with ACLS protocols. I remember back in the 70's that the first drug we gave in a code (even a witnessed arrest in the ER) was two amps of bicarb "because you can't shock...

Emergent airway management of a patient with his jaws "wired shut", especially in-hospital - cut the wires, VL or DL, place tube. I'll admit I didn't listen to the whole 15 minute video - but IMHO this patient did not have indications for a cric. There was time to consider more conservative...

I don't do central lines at my current gig, but I have probably put in a couple thousand central lines, including PA catheters, all without U/S guidance and going strictly by landmarks. With an IJ approach, I had zero incidence of pneumothorax, and never put a dilator/cordis in the carotid...

I guess anything that helps you get the tube in isn't necessarily a bad thing, and anything that optimizes your chances is useful to a point. However, your first attempt is not always your best attempt - sometimes you can't see an anatomical problem until you actually visualize it, and then...

Y'all are getting your terms confused. You really need to know the difference. A nuchal cord, which is quite common, is when the cord is wrapped around the babies neck at delivery. At delivery, unwrap the cord - problem solved. An umbilical cord prolapse, where the cord presents before the...

Ah, your time will come. :) As always, they have to come up with new rules and regulations and standards to justify their ongoing existence. Supplies not on the floor? Check. Supplies at least 18 inches from the ceiling? Check. Timeout before all procedures? Check. Hmmmm, what else...

Y'all are lucky you don't have to deal with The Joint Commission. They DEMAND that all our airway devices be kept clean/sterile and individually wrapped until time for use. We used to have oral and nasal airways loose in a drawer, and disposable laryngoscope blades loose in another drawer. No...

What do your hospitals use for post-intubation sedation? My guess is ketamine isn't it. And if you don't understand that there are tons of side effects associated with ketamine, you probably shouldn't be using it.

Might have told this before - but years ago I was walking back from a college football game. An elderly lady had collapsed outside The Varsity (those of you in Atlanta will know exactly where this is). CPR was started by a couple of ER nurses walking by. A medic who had been stationed at the...

As the saying goes, maybe you don't know what you don't know. Just because you do it your way doesn't mean it's the only way that's correct. I use a device called a Dial-a-Flow. It's a gravity flow device with a calibrated flow control. We use them in the OR all the time. If I NEED to know...

I have no experience with King airways - but just about any other SGA has seemed to be no better than a good old-fashioned LMA airway. We try a lot of different ones, but always come back to the LMA-style (varying manufacturers). Why? Because it works.

That holds true with pretty much anything. There is no federal law that relates to scope of practice for physicians, nurses, PA's, paramedics, EMT's, RT's, cosmetologists or interior designers (yes, some states license designers). Licenses to practice and scope of practice are all functions of...

Regardless of what people think is fair or not, or what they knew or didn't know when they were hired - there are wage and hour laws that deal with these situations, and if you are truly concerned about it and think it's not right, go see a labor attorney. You'd be surprised (or maybe wouldn't)...

I really like this dimensional screening concept! :)

Niacin has legitimate use for lowering triglycerides/cholesterol. If you start out at low doses and slowly build up, the side effects usually aren't a problem. But if you start with a high dose, or even change brands in some cases, the itching SUCKS! (personal experience). It's the main...

Lidocaine cures the common cold, venereal warts, and the heartbreak of psoriasis. Seriously - it is a great drug, and is used in virtually every anesthesia induction and intubation. And contrary to the AHA, it is a superb anti-arrhythmic drug that, at least in my institution, is much easier to...

A little background propofol infusion so they don't hear the drills and saws. :)

I'm sure you're doing as much multi-modal stuff as we are. Funny - in the 80's when I started out, we called it "balanced anesthesia". Now it's "multi-modal", just a different word for using a little of this and a little of that and not a lot of anything. We do a lot of fairly big cases with...

Ah, the ART of anesthesia. Procedures are the easy part.

Intubating the same mannequin 50 times does absolutely nothing to teach you about varying airway anatomy. Getting one-on-one training on real patients in the OR from someone with expertise is invaluable. Mannequins are a poor substitute. I've been involved with EMS airway training off and on...