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Avoiding Hypoxemia During Intubation
More than 1.5 million critically ill adults undergo tracheal intubation each year in the United States. Hypoxemia is a common and serious complication during tracheal intubation in critically ill adults, occurring up to 10-20% of intubations in the emergency department (ED) or intensive care unit (ICU). Hypoxemia increases the risk of cardiac arrest and death. The effect of preoxygenation with noninvasive ventilation, as compared with preoxygenation with an oxygen mask, on the incidence of hypoxemia during tracheal intubation is uncertain. In this breakdown of a Journal Club article, Dr de Castro will cover a recent paper comparing NIPPV to oxygen mask only during preoxygenation for intubation.
Intern Core Content: Disorders of the Adrenal Glands
Join Dr Haupt as she discusses the adrenal glands, their role in hormone production and other functions throughout the body, and common problems that can occur when the adrenal glands are not working properly. Although most of these issues are non emergent problems, occasionally they will be seen in some sort of acute adrenal crisis in the emergency department and ER physicians should be well versed in their often subtle presentations!
Is Hyperoxemia in Trauma Bad?
Severe trauma is the leading cause of death worldwide for adults younger than 50 years of age. Acute traumatic life support (ATLS) guidelines endorse early and aggressive usage of supplemental oxygen in patients with severe trauma, at least until abnormalities of airway or breathing can be safely ruled out. However, unclear target concentration, duration or saturation goals often leads to hyperoxemia. Emerging studies in the intensive care unit (ICU) setting suggest that liberal supplemental oxygen therapy and hyperoxemia is associated with increased mortality. Limited evidence in the trauma population suggests similar outcomes.