Tamingthesru
Grand Rounds Recap 10/7
Evidence Based Medicine on Tachydysrhythmias with Drs. Ludmer and Miller
- SVT is an umbrella term that includes AVNRT, atrial fibrillation and flutter, and polymorphic multifocal atrial tachycardia (MAT)
- AVNRT (AV Node Re-entrant Tachycardia) is the correct term for what is commonly diagnosed as SVT,
- MAT usually occurs in critically ill elderly patients with respiratory failure and is a poor prognostic sign, associated with 60% in hospital mortality. Treatment is to treat the causative pathology.
- REVERT Trial: Modified valsalva vs standard valsalva performed in 10 EDs with 428 patients in England. Findings included a 17% conversion with standard methods and 43% with the modified valsalva.
Fighting the Bugs
This is our first of 2 cases exploring the care of patients with sepsis in the Emergency Department. Similar to our "Out on a Limb" case series, the case presented is followed by a series of questions, with a discussion in the comment section facilitated by the post authors. In approximately 1 month (November 11th), the authors of the post will conduct a combined simulation/small group session reinforcing the learning points from the posts during Grand Rounds. Around this time, they will also curate the comments from the discussion and publish a post highlighting these learning points. Looking forward to a great discussion!
Ventilator Management Simulation Debriefing
Case 1 - "Bucking the Vent"
You have inherited a patient in the VA MICU at signout. The patient presented with spontaneous bacterial peritonitis and altered mental status and was intubated for airway protection and hypoxic/hypercarbic respiratory failure. The patient’s altered mental status has resolved but the patient remains intubated waiting for a second large-volume paracentesis that can’t be done over the long weekend at the VA. The RT calls you asking for a one time dose of 5mg Versed, but on a quick glance at the chart, the patient has been getting these Q2 hours for the last several days. You go to the bedside and find an agitated patient motioning to take out the tube. “He’s bucking the vent doc!”
Vent settings: AC-VC: TV500 RR12 PEEP8 FiO2 30%