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We certainly use it for all of those reasons. The caveat, of course, is that NIPPV is really optimal for quickly-resolving problems, and these rib fracture/lung contusion patients will usually take days to get past the hump (they often don't even "peak" for a day or two). Continuous CPAP/BIPAP...

Well... one that doesn't require a mask seal.

Interesting. Would you say it's true, however, that when something like an LMA gives you trouble, you can often still ventilate through it to some degree (i.e. it remains a usable rescue airway), albeit imperfectly -- whereas when endotracheal intubation fails, it fails completely?

They are easier in the sense that you don't need to visualize the glottis, which is much of the challenge in intubation. I presume you're saying this is balanced by some other aspect of their use that's harder?

I agree it is probably not a big deal and I do it too. Still, it's a consideration.

The exterior of the syringe is not sterile. Extruding some of the (sterile) saline and using that space to pull up a medication involves "doubling back" over a portion of the draw, therefore exposing the internal chamber of the syringe to its non-sterile exterior.

These are technically not sterile. That being said, it's probably about as sterile as many instances of venous access...

Here's my notes from the course! http://critcon.org/archives/489

I would NOT be using this sort of thing to rule out coronary ischemia. Spicy food is not cardioprotective. This is not right. Nitro has not been clearly shown to improve outcomes in ACS. This sounds both wrong and dangerous and dangerously wrong. This sounds both wrong and irrelevant. If...

http://emsbasics.com/2012/10/26/managing-stemi-mimics-in-the-prehospital-environment-video-lecture/ I agree that being really good at recognizing ischemia on the ECG, even with subtle or hidden manifestations, is the tool that will get you the furthest here. If the patient presentation isn't...

This is an interesting idea, and not one that I've seen supported in the literature (i.e. that higher flows are associated with more lung injury). I suppose one could argue that the more rapidly you expand alveoli, the more damage you cause them, but I don't know. Most "atelectrauma" is probably...

Sorry -- http://critcon.org/

For sure. I'll probably write it up for my site.

It's well regarded. I'm going in April. Levitan is not the most mainstream airway educator and has some slightly idiosyncratic views, but I have no doubt it's worth the time and money.

Of course you're right that there's no sense in making trouble if it can be avoided. But I'm not sure I agree that elevated peak pressures due to a small tube increase the risk of barotrauma. Those pressures are not occurring in the lungs; they are solely upstream of the tube.

I would put this a little differently. Elevated peak pressures due to a small tube have very little relevance to the lungs at all; it is mostly annoying because your alarms will need adjusting (and the same people who get freaked out by high blood pressures will call you a lot). You can force...

I assume you mean this more as a general concept (aiming to place a tube a little smaller than one you think you'd have to cram in) than a practical one -- I assume you are not intubating by passing larger and larger tubes until you reach one that doesn't fit, then downsizing by one...

Yes, a tighter tube make life a little more annoying, requiring higher peaks, making it difficult to bronch, etc. The answer is to place the largest tube you can fit without needing one of those post-diggers. (Most folks can take an 8.0.) I suppose you could view this as matching the size to the...

It's not really a matter of size. We don't select tube size to match trachea size, like fitting a hand into a glove, other than in a very general sense ("Can't seem to cram an 8.0 into this one, let's try smaller"). This is because the cuff molds to fit the surrounding airway. Since that may...

I'd say it is more or less the standard of care in the ICU.