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Thanks! Part II to come.

Depends on the block. Fingers (usually a ring block) are easy. Some fancy stuff like femorals use the 'sound. (Not real lingo.)

I think there's a distinction here between the routinely-binging found-down often-homeless in-and-out of the ED frequent fliers, and the fairly stable "pint or two a day" drinkers who actually tend to stay out of the hospital. Interestingly it usually seems to be the latter who admit as major...

Zactly. I'm all for rationalizing and simplifying, but at some point it's like asking for an RCT before you'll give people pillows.

Fair enough. Although if we're really going to start rooting through the drug box and asking which meds have good evidence that they need to be given in the field, it may quickly turn into a drug wallet. At some point things end up as prehospital therapies merely under the philosophy of...

Jeez, just give the thiamine, people. You're not saving the world here.

Sure thing. But the last portion of the tutorial is the most important -- deciding what individual approach to bag-mask ventilation makes sense for you in your own setting. Collecting all the theoretical pearls in the world won't be much help otherwise. We all probably "know" a lot of things...

I had an old series on this with some pearls and pointers. http://emsbasics.com/2012/07/01/mastering-bls-ventilation-introduction/ Taught a BLS continuing ed course on same for a while too.

From an ICU perspective, it is done, but I see no advantage and tend to change it when I encounter it. Lorazepam has a long half-life, making it less titratable as a drip, and infusions are packaged in propylene glycol which can cause weird metabolic acidoses. Midazolam is better -- although...

I think there are certainly times when it's appropriate, or at least inevitable. I think we're just disagreeing about timeframe. For me this would be in the realm of minutes (pushing some pressor while you await blood, or, yes, a fluid bolus), basically to prevent arrest. Pushing it much beyond...

Maybe not then. That has certainly been my experience.

I think if you reflect back upon the times when someone tried to treat hypovolemic shock with pressors, you'd remember that it didn't work very well, didn't last very long, and in the end was a temporizing measure at best and perhaps a smokescreen at worst (i.e. treating the number without...

Bear in mind that the sodium is not usually truly low in DKA. There may, however, be pseudohyponatremia, which is not clinically important except as a confounder.

The inspiratory pressure you set in PCV is the driving pressure created by the vent (on top of PEEP); no pressure within the airway will exceed this. Early in the breath, much of this pressure will be from airway resistance, and the "plateau" is low here (although not measurable). As flow...

If you're pointing out that patient-ventilator dyssynchrony can elevate the variables you mentioned, obviously this is true. But this is primarily a result of discomfort and sympathetic activation. I can also elevate the heart rate by vigorously poking the patient with a stick. The solution is...

1. This is not magic. The PCV is probably just ending up with a longer I time. 2. This is not good. Set tidal volume based on what's lung protective and what's needed for ventilation. Bigger is worse, not better. 3. Ignore peak pressures. Plateau is what's relevant to most of our interests.

I think it's important to distinguish peak versus plateau pressure. Most of what you're describing involves higher PEAK pressures. As I'm sure you recognize, the peak pressure (the driving pressure, measured and generated at the ventilator) is produced by a combination of two forces: the...

In what respect does pressure control allow you to give more volume for a given pressure or make it easier to overbreathe?

Eh... eh? Not sure I understand the argument for either of these points.

Yep!