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Could be the epi.

Just not so popular these days. More tendency to provoke tachyarrythmias than most and increases myocardial demand quite a bit. Promotes diuresis, not a great thing in sepsis. Not a terribly predictable dose-response curve. Nowadays it's usually norepi then pick your poison.

With a valve and an adequate flow through the cannula you do have some PEEP. Take a look at the video on the page I linked where it's demo'd using a cufflator to check pressure within the circuit. He gets a nadir of 5ish cmH2O or around there.

No, not necessarily, although it would apply there too. As I understand it this is mainly for preoxygenating the spontaneously breathing patient prior to RSI, particularly when they are difficult to properly oxygenate due to shunt. Actual CPAP/BiPAP (or doing it with the vent) is another option...

Like many easily-misunderstood concepts, this notion of cannula-under-BVM-with-PEEP may have originated with Scott Weingart. He has some info (and a demonstration video) here: http://emcrit.org/preoxygenation The idea is essentially that PEEP is invaluable to help oxygenate many patients with...

Wouldn't you say it's rather unusual to have COMPLETE obstruction of the airway, even in difficult cases? Difficulty arises from difficult masking, poor visualization, difficulty passing the tube, etc not usually because the glottis is totally sealed (obviously I mean during laryngoscopy, not...

I think it's meant to allow immediate intubation once you pass the bougie, without the need for helpers who aren't always present or may not know your shtick. Surely in most cases elevation of the blade during laryngoscopy will clear said obstruction by prognathing the jaw?

Speedy, You're referring to "apneic oxygenation," a concept Scott and some others have been championing for a while now. The basic principle (as you hinted at) is that if you can maintain a high concentration of oxygen in the pharynx and upper airways, it will indeed continue to flow into the...

And FWIW I agree Solumedrol isn't usually the drug of choice so not sure why that's what they settled on. Maybe logistical reasons.

As Remi said, I wasn't referring to specific corticosteroid choices. But there is evidence that early stress dosing (i.e. prehospital vs ED time is relevant) makes a difference to outcomes. Massachusetts started carrying methylpred for that reason and I believe other regions have done the same...

Can be important for adrenal insufficiency.

Not the same thing. I don't know of anything that would cause true dilation to light. Might have been a visual illusion.

Brilliant! Fascinating stuff.

This is a naive question, but I never entirely understood the role of opioids (fentanyl, dilaudid, etc) in general anesthesia. (I'm in a surgical ICU now and dealing with it daily.) Is the idea that to bring make them totally insensate would require far deeper anesthesia than if you combined...

Is volatile anesthesia less suppressing to the respiratory drive than IV sedation? I have a hard time imagining taking someone deep enough to cut them open while maintaining spontaneous breathing using something like propofol.

This would be for IV anesthesia? Or can you run gas through an LMA?

Sounds challenging to keep them deep enough for surgery while still retaining a reasonable respiratory drive?

Correct me if I'm wrong, but by "spontaneously" you mean "on a spontaneous mode" meaning "still receiving positive pressure ventilations." You don't stick in an LMA and leave them sucking air through a T-piece or something during the case.