Ever have that critical pneumonia ARDS patient that just cannot be safely transported without a temporizing (or longer) fix? Join Dr. Ferreri on a case study and deep dive into the physiology behind Epoprostenol use in Transport Medicine.
Read MoreCardiogenic Shock can humble the finest of critical care crew. Knowing the physiology and new adjuncts that can be a critical part of resuscitation can salvage the sickest LVs out there. Take a deep dive into cardiogenic shock and Impella support with Dr. Adam Gottula
Read MoreAirway devices abound both in the ED and in the prehospital environment. Over the past few decades the use of extraglottic devices has increased significantly. In this post, Dr. Andrew Cathers recaps a recent article from Annals of Emergency Medicine where the authors sought to categorize these devices by the ways in which they are placed and to then apply that categorization to a cohort of deceased patients to hopefully shed light on the use and failures of these devices.
Read MoreThis is a great paper recently presented at the Critical Care Transport Medicine Scientific Forum. It covers a subject area I have always been interested in. Over time, our understanding of critical care has evolved to show the importance of a low tidal volume strategy for ventilating patients, particularly those with lung injury/ARDS. However, even patients with normal lungs are potentially harmed by high tidal volume strategies.
Read MoreTransport of the ECMO patient is no small task, requiring intentional preparation. Join the UC Health Air Care & Mobile Care ECMO transport team to review VA ECMO Basics for Critical Care Transport Medicine.
Read MoreNormal saline has taken hold as the de facto resuscitative fluid in the majority of health care institutions in the developed world. Walk through the recent data with Dr. Christopher Shaw which suggests that balanced fluids may provide benefit to patients suffering from a wide array of critical illnesses.
Read MoreWe are all familiar with the “lethal triad” of trauma – coagulopathy, hypothermia, and acidosis. We have multiple methods wherein we attempt to prevent or reverse these physiologic derangements. In particular, in recent years many teams have focused heavily on limited crystalloid infusions, increasing our early blood product transfusion (especially plasma), and early administration of tranexamic acid.
One of the main reasons we focus on these interventions is to address trauma-induced coagulopathy. Trauma-induced coagulopathy has a multifactorial etiology and is contributed to by the other corners of the triad (hypothermia and acidosis). However, one of the least appreciated contributing factors are electrolyte deficiencies, in particular calcium.
Read MoreThe treatment of Acute Ischemic Stroke is a rapidly evolving field with critical care transport medicine playing an increasing role in the treatment of these patients. Dr. Irankunda explores CCTM specific management and historical musts when treating this unique patient population. Dr. Gottula provides a brief review of the literature supporting IV alteplase and endovascular thrombectomy.
Read MoreHypokalemia is a commonly seen laboratory abnormality which is often unappreciated in the emergency department. Join us as we take a deep dive into the presentation and life threatening consequences of a patient with severe hypokalemia as we review a previous case from an international leader in critical care transport medicine, Air Care.
Read MoreNo Lung? No problem! Join Liz Powell, Paige Barger and Adam Gottula as they take a look at the basics of VV ECMO in the transport environment.
Read MoreTrauma scene flights are often the first thing people think of when they think of Helicopter EMS. Although we know that HEMS and Critical Care Transport involves much more than just scene flights, they are still a critical part of most HEMS programs’ mission and capabilities. In addition, many flights are “modified scenes” or “scene intercepts,” meaning the HEMS crew meets the EMS crew at an outlying hospital helipad, or arrives shortly after the patient’s arrival to an under-resourced ED. Many of these patients are critically ill, and a subset will require intubation and ventilation. Once intubated is bag valve ventilation enough? Or should all these patient’s be placed on a mechanical ventilator?
Read MoreInvasive ventilation is one of the most frequently applied interventions utilized for critically ill patients. However, as with all medical interventions, there are potential risks and harms which must be balanced with perceived benefit. As our understanding of physiology grows, we have found more and more potential harms associated with invasive mechanical ventilation. This review of a recent article published in JAMA explores the impact of different tidal volume strategies for patients who do not have ARDS.
Read MoreWe know that alterations in hemodynamics do not only occur in hemorrhagic shock. Both obstructive (such as from tension pneumothorax) and neurogenic shock (for example, from a spinal cord transection), can result in hemodynamic compromise that would not be corrected by blood product administration. There have been some studies that have shown isolated traumatic brain injury (TBI) can also cause hemodynamic derangements. This article looks at a paper which attempts to examine the incidence of cardiovascular instability in patients with TBI.
Read MoreWe train for it, we have a healthy fear of it, and we realize that having to perform one is not an admission of failure on our part. But, how often is a cricothyrotomy performed on HEMS. Dr. Andrew Cathers of University of Wisconsin Med Flight walks through a recently published paper on the topic.
Read MoreCardiogenic shock presents many challenges in both the transport environment and hospital setting. We aim to review the current state of evidence pertaining to the medical management in the critical care transport environment.
Read MoreSRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
