Podcasts about nippv

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.

The JournalFeed podcast for the week of Jan 6 – 10, 2025.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Wednesday Spoon Feed:Tranexamic acid reduces the risk of life-threatening postpartum bleeding with no measurable increased risk of thrombosis.Thursday Spoon Feed:High-velocity nasal insufflation (HVNI) was non-inferior to noninvasive positive pressure ventilation (NiPPV) for treating acute exacerbations of chronic obstructive pulmonary disease (COPD) in the emergency department.

Every great resuscitationist needs to understand the fine points of keeping your patients breathing - not only by securing an airway, but also by understanding ongoing ventilation. In this episode, EMRA*Cast host Blythe Fiscella, MD, reviews pearls and pitfalls of NIPPV with critical care expert Colin McCloskey, MD.

Send us a textIn this episode, Ben and Daphna are joined by Dr. Amit Mukerji, MD, MSc, neonatologist and associate professor at McMaster University, to discuss his groundbreaking research on the use of high CPAP pressures in preterm neonates. Dr. Mukerji presents insights from his pilot trial comparing CPAP to NIPPV at equivalent mean airway pressures, challenging conventional approaches to non-invasive respiratory support. He addresses concerns about failure rates, cultural biases in clinical practice, and the importance of proper pressure application. This conversation highlights the potential of high CPAP pressures to simplify care while maintaining efficacy for most preterm infants.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

The principles of preoxygenation and passive oxygenation should be familiar to any experienced intubator. Best practice recommends the use of a nasal cannula in conjunction with either a non-rebreather mask or bag-valve mask (BVM) to prevent hypoxemia during the apneic phase of Rapid Sequence Intubation (RSI). In the PREOXI Trial, the authors pushed this concept further, questioning whether non-invasive positive pressure ventilation (NIPPV) might be more effective than these formally mentioned adjuncts. In this podcast, we dive into the strengths and weaknesses of the trial and explore whether its findings are truly practice-changing. We might even disagree along the way… (We also provide a rebuttal to some of the feedback we received on our previous podcast episode.) Get CE hours for our podcast episodes HERE! -------------------------------------------- Twitter @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: The views, information, or opinions expressed on the Heavy Lies the Helmet podcast are solely those of the individuals involved and do not necessarily represent those of their employers and their employees. Heavy Lies the Helmet, LLC is not responsible for the accuracy of any information available for listening on this platform. The primary purpose of this series is to educate and inform, but it is not a substitute for your local laws, medical direction, or sound judgment. --------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com

In this month's EM Quick Hits podcast: Andrew Petrosoniak on the role of vasopressors in the hemorrhaging trauma patient, Megan Landes on providing HIV PEP and PrEP in the ED, Justin Morgenstern & George Kovacs on the PREOXI trial and evidence for pre-oxygenation with NIPPV before intubation in RSI, Brit Long on recognition and management of blast crisis in the ED, and Leah Flanagan & Liam Loughrey on the rise of nitrous oxide toxicity...

In this part 2 of our 2-part podcast on asthma with Dr. Sameer Mal and Dr. Leeor Sommer, we dig into the recognition and management of life-threatening asthma. We answer such questions as: what are the key elements in recognition of threatening asthma? What are the most time-sensitive interventions required to break the vicious cycle of asthma? What are the best options for dosing and administering magnesium sulphate, epinephrine, fentanyl and ketamine in the management of the crashing asthmatic? What is the role of NIPPV in the management of life-threatening asthma? What are the factors we should consider when it comes to indications for endotracheal intubation of the crashing asthmatic? What role do blood gases play in the decision to intubate? What are the most appropriate ventilation strategies in the intubated asthma patient? and many more... The post Ep 193 The Crashing Asthmatic – Recognition and Management of Life Threatening Asthma appeared first on Emergency Medicine Cases.

About one in ten live births around the world are preterm and many of these babies will develop respiratory distress and require help with their breathing. Various strategies are available for this and an updated Cochrane review from July 2023 provides the latest evidence on the comparison of nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure when a baby's breathing tube is removed. We asked one of the authors, Marc-Olivier Deguise from the Children's Hospital of Eastern Ontario in Canada to tell us about the findings, and he used ElevenLabs to make this recording.

About one in ten live births around the world are preterm and many very preterm babies will develop respiratory distress soon after birth and require help with their breathing. Various strategies are available for this and an updated Cochrane review from July 2023 provides the latest evidence on the early use of nasal intermittent positive pressure ventilation compared with nasal continuous positive airway pressure. We asked one of the authors, Marc-Olivier Deguise from the Children's Hospital of Eastern Ontario in Canada to tell us about the findings, and he used ElevenLabs to make this recording.

About one in ten live births around the world are preterm and many of these babies will develop respiratory distress and require help with their breathing. Various strategies are available for this and an updated Cochrane review from July 2023 provides the latest evidence on the comparison of nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure when a baby's breathing tube is removed. We asked one of the authors, Marc-Olivier Deguise from the Children's Hospital of Eastern Ontario in Canada to tell us about the findings, and he used ElevenLabs to make this recording.

About one in ten live births around the world are preterm and many very preterm babies will develop respiratory distress soon after birth and require help with their breathing. Various strategies are available for this and an updated Cochrane review from July 2023 provides the latest evidence on the early use of nasal intermittent positive pressure ventilation compared with nasal continuous positive airway pressure. We asked one of the authors, Marc-Olivier Deguise from the Children's Hospital of Eastern Ontario in Canada to tell us about the findings, and he used ElevenLabs to make this recording.

The "Pandemic Immunity Gap" is likely behind the massive surge in respiratory syncytial virus (RSV), with current CDC data showing a 275% increase from 2020-2021 to 2022-2023. The most vulnerable population is between 0-6 months old, which often raises the stress level for providers across all spectrums. Join Eric for a deep dive into a case study involving a 4-month-old male in acute respiratory compromise. We break down the progression of RSV and its association with bronchiolitis. Dive deep into the current evidence on fluid management, bronchodilators, corticosteroids, NS 0.9%, Hypertonic 3%, racemic epinephrine, HFNC, NiPPV, intubation, and much more.  Recommended flow settings and cannula sizes for high-flow nasal cannula therapy in pediatric patients https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027347/table/t1-kjp-2019-00626/?report=objectonly Corticosteroid Therapy During Acute Bronchiolitis in Patients Who Later Develop Asthma: Hosp Pediatr (2017) 7 (7): 403–409. https://doi.org/10.1542/hpeds.2016-0211 Efficacy of 3% hypertonic saline in bronchiolitis: A meta‑analysis,  Received May 10, 2018; Accepted August 22, 2018. DOI: 10.3892/etm.2019.7684 Respiratory syncytial virus: diagnosis, prevention and management: Ther Adv Infectious Dis 2019, Vol. 6: 1–9 DOI: 10.1177/2049936119865798 https://journals.sagepub.com/doi/epdf/10.1177/2049936119865798 Gadomski AM, Brower M. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2010;12CD001266. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001266.pub4/full Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis https://www.bmj.com/content/342/bmj.d1714 High-dose inhaled corticosteroids' effect on wheezing in infants after respiratory syncytial virus infection: a randomized, double-blind placebo-controlled trial. Ermers MJ, Rovers MM, van Woensel JB, Kimpen JL, Bont LJ; RSV Corticosteroid Study Group. High-dose inhaled corticosteroids' effect on wheezing in infants after respiratory syncytial virus infection: a randomized, double-blind placebo-controlled trial. BMJ. 2009;338:b897. Heliox inhalation therapy for bronchiolitis in infants Liet JM, Ducruet T, Gupta V, Cambonie G. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database Syst Rev. 2010;4:CD006915.See omnystudio.com/listener for privacy information.

Non-invasive positive pressure ventilation or NIPPV is ventilatory assistance without an invasive artificial airway like an endotracheal tube. The oxygen is delivered to a spontaneously breathing patient through a tight-fitting mask or in this case a helmet. Helmet based ventilation is a modern solution to an outdated method. The most popular choice in providing NIPPV is the cpap, a tightly fitted mask over the nose and mouth. The biggest problem with cpap is comfort and inconsistency associated with interruption for patient care. The helmet based approach provides a more efficient and effective way to deliver pressure and oxygen. In this episode, we welcome our guest, Aurika Savickaite. She is a registered nurse and patient care manager at the University of Chicago Medical Center's Medical Intensive Care Unit and was part of the successful testing of the helmet ventilator in the ICU at the University of Chicago during a three-year trial study. Catch more of Aurika as we learn more about helmet ventilation and empowering nurses in this exciting episode of Cup of Nurses.

Infants in the NICU are patients that require specialized care with unique clinical considerations. Specific recommendations must be considered for all systems of NICU patients and the skin is not any different. Infants who are being cared for in the NICU, especially those that were born premature have an increased risk for skin trauma. On this episode, we review some of the skin care guidelines and recommendations available for clinical practice of NICU patients. As NICU clinicians, is is important to not only be aware of the anatomical variations of a term and preterm infant's skin, but to also know how that guides their clinical care and treatment plan. Many of the topics we cover on this episode have been standards of care for years, but there are also new recommendations for practice and products available based on recent research findings. NICU clinicians will hear a great review as well as up-to-date clinical recommendations for skin care of our specialized population in the NICU. The episode will also be beneficial for parents to hear the clinical practice guidelines and recommendations for term and preterm infants as well as some of the variations that may exist between different institutions. Our NICU Roadmap: A Comprehensive NICU Journal: https://empoweringnicuparents.com/nicujournal/NeoTech Products: https://www.neotechproducts.com/Solly Baby: http://shrsl.com/2py8hNICU Mama Hats: https://empoweringnicuparents.com/hats/NICU Milestone Cards: https://empoweringnicuparents.com/nicuproducts/Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/episode36Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/Empowering NICU Parents FB Group: https://www.facebook.com/groups/empoweringnicuparentsPinterest Page: https://pin.it/36MJjmH

Clinicians use noninvasive respiratory support interventions in the post-extubation period to mitigate the risk of extubation failure. These interventions [noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC)] have been shown to be efficacious in preventing initial intubation in patients with hypoxemic respiratory failure, but their efficacy in preventing post-extubation respiratory failure and reintubation is less clear. A systematic review and network meta-analysis of randomised controlled trials (RCTs) to evaluate the relative efficacy of conventional oxygen therapy, NIPPV, HFNC, and the strategy of alternating NIPPV and HFNC during the post-extubation period in reducing extubation failure and short-term mortality among critically ill adults, was conducted. We have interviewed Dr Fernando and Dr Rochwerg to explain these study findings. Speakers Shannon FERNANDO. Division of Critical Care, Department of Medicine, University of Ottawa (CA). Bram ROCHWERG. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton (CA) and Department of Medicine, Division of Critical Care, McMaster University, Hamilton (CA). Ahmed ZAHER. Oxford University Hospitals (UK). ESICM Next Committee member.

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat and I'm Rahul Damania. We are coming to you from Children's Healthcare of Atlanta - Emory University School of Medicine. Welcome to our Episode a 15 mo F with respiratory distress and runny nose. Here's the case: A 15 mo F presents to the ED with cough, runny nose, and increased work of breathing. Her mother states that the patient has had these symptoms for the past three days, however, the work of breathing progressed. The patient has had 2 fevers during this course, with the highest 101F. She says that her 3 yo cousin who she visited for the holidays had similar symptoms. Mother notes decreased PO and wet diapers. The patient presented to the ED with the following vital signs: T 38.5C, HR 155, BP 70/48 (MAP 50), RR 48, 92% on RA. The patient on the exam was noted to be tachypneic with abdominal retractions, grunting, and nasal flaring. The patient was nasally suctioned and initiated on 12 L 40% of HFNC. The patient was then transferred to the PICU for further management. To summarize key elements from this case, this patient has: Increased work of breathing indicates respiratory distress. She has a prodrome of symptoms that worsened prior to presentation And a sick contact. All of which brings up a concern for acute respiratory failure requiring non-invasive positive pressure ventilation in the form of HFNC. Let's transition into some history and physical exam components of this case? What are key history features in this child who presents with respiratory distress & URI sx? Usually, children under the age of two with bronchiolitis will present with cough, respiratory distress, and crackles on lung exam. The crackles indicate atelectatic alveoli that are filled with fluid which occurs due to inflammatory processes in the lung triggered by respiratory viruses. Respiratory distress, increased work of breathing, respiratory rate, and oxygenation all can change rapidly with crying, coughing, and agitation. Are there some red-flag symptoms or physical exam components in a child with acute respiratory distress which you could highlight? That is a great question. We really want to highlight the distinction between respiratory distress and respiratory failure. Children with respiratory failure in our case may have issues with oxygenation or ventilation as well as increased work of breathing that necessitates higher levels of respiratory support like HFNC. In a 2003 Journal of Pediatrics study, infants who were most severely affected with bronchiolitis were born prematurely,

In this Part 1 of our two-part series on acute heart failure, Anton is joined by Dr. Tarlan Hedayati and Dr. Bourke Tillman to answer such questions as: how does PoCUS compare with clinical assessment and CXR in diagnostic accuracy for acute heart failure? How do we best integrate PoCUS in the our assessment and management of the patient with acute heart failure? What is PPV HAVoC and how can we use it to optimize acute heart failure management goals? What should be our specific goals of management in the acute heart failure depending on the underlying cause? How does high flow nasal cannula (HFNC) compare to non-invasive positive pressure ventilation (NIPPV) in the management of acute heart failure? How should we interpret the C3PO trial in the context of the world's literature on NIPPV in acute heart failure? How should we dose nitroglycerin to maximize its effects without dumping the blood pressure in patients with SCAPE and those without SCAPE? How should we best time and dose furosemide in the acute heart failure patient with renal insufficiency? Is there any role for morphine or ACEi in the ED management of acute heart failure? What are best anxiolytic medication choices in acute heart failure? Is there any role for second line diuretics in the management of acute heart failure in the ED? and many more... The post Ep 163 Acute Heart Failure ED Management – PoCUS, Oxygenation Strategies, Medication Strategies, PPV HAVoC and SCAPE appeared first on Emergency Medicine Cases.

Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists. My name is Pradip Kamat. And my name is Rahul Damania, we come to you from Children's Healthcare of Atlanta/Emory University School of Medicine. Today's episode is dedicated to Noninvasive and Invasive ventilation in children post-hematopoietic cell transplantation. We are delighted to be joined by Dr. Courtney Rowan, MD, MSCR, Associate Professor of Pediatrics, and the Director of the Pediatric Critical care Fellowship at Indiana University School of Medicine/Riley Children's Health. Dr. Rowan's research interest is in improving the outcomes of immunocompromised children with respiratory failure. She is active in this field of research and has led and participated in multi-centered studies. She is the co-chair of the committee of the hematopoietic cell transplantation subgroup of the Pediatric acute lung injury and sepsis investigators network. In our podcast today we will be asking Dr. Rowan about the findings of her recent study published in the journal-Frontiers in Oncology reporting on the risk factors for noninvasive ventilation failure in children post hematopoietic cell transplant. She is on twitter @CmRowan. Patient CaseI will turn it over to Rahul to start with our patient case... A 15-year-old female with a history of AML s/p Allogeneic hematopoietic stem cell transplantation T+15 days presents with tachypnea and a new O2 requirement. She has been on the BMT floor for 48 hrs after being admitted for respiratory distress and fevers. Her blood cultures are negative but she is febrile intermittently. Her CXR shows nonspecific haziness, no focal opacity, and underinflation. Her weight is up 2KG in the last 48 hours. She is found to have increased work of breathing and mild desaturations to 88%. She is placed on HFNC and continued on broad-spectrum antibiotics. A respiratory viral panel and Sars-CoV-2 PCR is sent. Transfer to the Pediatric ICU is initiated. Episode DialogueDr. Rowan, welcome to our PICU Doc on-call podcast. Dr. Rowan: Thanks Rahul & Pradip for having me. I am delighted to be here to discuss one of my favorite topics. I have no conflicts of interest but I have funding from the NHLBI. Today we will be discussing the up-to-date evidence for NIV (HFNC and NIPPV) use in children who have had BMT. Additionally, we will also be discussing the use of invasive MV strategies including HFOV in the pediatric BMT population. To start us off, Dr. Rowan, why is the BMT cohort different from other patients admitted to the PICU? There is an increase in the # of patients undergoing BMT as indications for BMT are being expanded to different disease processes. The Etiologies for lung disease in BMT patients can be infectious (common organisms as well as opportunistic organisms). They can have lung disease from non-infectious causes and even fluid overload from renal dysfunction/medications given and there is a constant threat of alloreactivity which can manifest as GVHD or engraftment syndrome. 75% of PICU admits of immunocompromised children come from the heme-onc inpatient services. BMT patients have a higher risk to progress to ARDS. Recent reports show the incidence of ARDS in the intubated BMT population reaching upwards of 92%. These patients are also at high risk for MODS and can have a mortality rate close to 60%.

As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. Papers discussed in today's episode are listed and timestamped below.enjoy!01:30 - Immediate “Kangaroo Mother Care” and Survival of Infants with Low Birth Weight https://www.nejm.org/doi/10.1056/NEJMoa202648613:45 - Influence of different breast expression techniques on human colostrum macronutrient concentrations. https://www.nature.com/articles/s41372-021-00989-918:00 - Migration of cyclohexanone and 3,3,5-trimethylcyclohexanone from a neonatal enteral feeding system into human milk. https://www.nature.com/articles/s41372-021-01036-322:50 - Changes in macronutrients of human milk after bolus feeding: a simulation study. https://www.nature.com/articles/s41372-020-00899-227:45 - Maternal dietary fat intake during pregnancy and newborn body composition. https://www.nature.com/articles/s41372-021-00922-0 32:40 - Body adiposity and oral feeding outcomes in infants: a pilot study. https://www.nature.com/articles/s41372-021-00975-134:55 - Breastfeeding and growth trajectory from birth to 5 years among children exposed and unexposed to gestational diabetes mellitus in utero. https://www.nature.com/articles/s41372-021-00932-y38:55 - The effects of probiotic supplementation on the gene expressions of immune cell surface markers and levels of antibodies and pro-inflammatory cytokines in human milk. https://www.nature.com/articles/s41372-020-00875-w45:14 - Comparison of standard versus high-dose ibuprofen for the treatment of hemodynamically significant patent ductus arteriosus in preterm infants. https://www.nature.com/articles/s41372-021-01046-149:00 - Patent ductus arteriosus shunt elimination results in a reduction in adverse outcomes: a post hoc analysis of the PDA RCT cohort. https://www.nature.com/articles/s41372-021-01002-z56:19 - Temporal and seasonal variations in incidence of stage II and III NEC—a 28-year epidemiologic study from tertiary NICUs in Connecticut, USA. https://www.nature.com/articles/s41372-021-00961-761:15 - Invasive mechanical ventilation at 36 weeks post-menstrual age, adverse outcomes with a comparison of recent definitions of bronchopulmonary dysplasia. https://www.nature.com/articles/s41372-021-01102-w62:35 - High CPAP vs. NIPPV in preterm neonates — A physiological cross-over study. https://www.nature.com/articles/s41372-021-01122-6        

In this episode, we review non-invasive ventilation in the NICU, respiratory support without an endotracheal tube, but rather with a nasal cannula or face mask. If your baby currently has or had Respiratory Distress Syndrome, the chances are quite high that they are currently or were previously on at least one of the different modes of non-invasive ventilation, either nIMV or NIPPV, CPAP, HFNC, LFNC. This is a topic, I know so many of you will benefit from hearing. After listening, you will walk away with a much better understanding of the different options of non-invasive ventilation, why one method may be chosen over another, how they will be beneficial to your baby, and some of the potential complications. Tune in to gain a better understanding of the parameters set on each of the different modes of non-invasive ventilation including but not limited to rate, PIP, PEEP, i-time, L/min and FiO2. Grab your free graphics that correlate with the episode at: http://empoweringnicuparents.com/rds/https://empoweringnicuparents.com/nicuimage/Empowering NICU Parents Show Notes:https://empoweringnicuparents.com/episode11/Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/Empowering NICU Parents FB Group:https://www.facebook.com/groups/empoweringnicuparents

Breathe easy with these airway management principles and expert tips for managing the patient with COVID-19 related lung disease (i.e. pneumonia, hypoxemia, ARDS). In the COVID-19 era, non-intensivists are being called upon to care for critically ill patients across the globe. At the Curbsiders, we understand that this can be a stressful proposition! Therefore, we’ve enlisted the help of the renowned medical intensivist & USUHS Chair of Medicine, Dr. Kevin Chung (@chungk1031) to teach us what we need to know about airway management  in these challenging times.   Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com    Credits Written and Produced by: Cyrus Askin MD, Michael Rose MD, Kathleen Hiltz MD Show Notes: Cyrus Askin MD Infographic: Elena Gibson, MD Cover Art: Dr. Kate Grant MBChB DipGUMed Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Cyrus Askin, MD    Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com Guest: COL Kevin Chung, MD, FACP   Sponsor AccessMedicine is the acclaimed online medical resource that features Harrison's Principles of Internal Medicine and more trusted content from the best minds in medicine. Visit  AccessMedicine to learn more: http://bit.ly/MHCurbsiders.   Time Stamps 00:00 Sponsor - AccessMedicine by McGraw Hill http://bit.ly/MHCurbsiders  00:15 Disclaimer, intro, guest bio 03:15 Guest one liner, chicken wings (Miller Lite marinade), career advice 07:40 Sponsor - AccessMedicine by McGraw Hill http://bit.ly/MHCurbsiders  08:20 Case of hypoxemic respiratory failure; Rapid evaluation, initial labs 16:03 Initial assessment of a COVID-PUI; HFNC and non-invasive ventilation 23:40 Proning patients for hypoxemia 29:15 ARDS basics: diagnostic criteria, Brief Recap 33:22 Mechanical ventilation: Initial settings, following the blood gas 40:55 Peak and plateau pressure, Lung compliance and  Troubleshooting a high pressures 51:30 Ventilator dyssynchrony; Lung compliance and traditional ARDS vs COVID-19 lungs 62:55 Advanced ARDS - The 5 Ps of therapy and differences with COVID-19 68:10 Take home points; Plugs; Outro   Links Internet Book of Critical Care (IBCC) Podcast by Dr. Josh Farkas - COVID-19 Dr. Jessica Bunin’s Video Lecture on Vent Basics for Non-Intensivists COVID-19 Toolbox One-Stop for some COVID-19 video content, also on the COVID-19 Toolbox Site   Goal Listeners will be equipped with the basics to provide ventilatory support, to include the use of mechanical ventilation, for critically ill patients in the COVID-19 era.   Learning objectives After listening to this episode listeners will…   Appreciate the unique challenges faced by the medical community as pertaining to the current COVID-19 pandemic. Be familiar with fundamentals of critical care as pertaining to airway management. Define the diagnostic criteria of ARDS and appreciate early clinical signs that may indicate a patient is developing ARDS. Review the various non-invasive methods of assisting with oxygenating & ventilating a patient (NC, NRB, HFNC, NIPPV, etc.) and any key contraindications. Recognize signs suggestive of impending respiratory failure requiring invasive mechanical ventilation (i.e. indications for intubation). Be familiar with basic ventilator parameters, basic terminology / modes. Know initial vent settings for a patient with resp failure / ARDS based on ARDSnet data. Have an approach to titrating vent settings based on physiologic parameters & the blood gas. Know special considerations for management of ARDS in a patient with COVID-19. Be familiar with advanced management strategies for patients with ARDS such as proning and paralysis   Disclosures Dr. Chung reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Chung, K, Askin C, Rose M, Hiltz K, Gibson E, Williams PN, Watto MF. “206 Airway Management for the Non-Intensivist”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list 04/13/2020.

NON-INVASIVE +VE PRESSURE VENTILATION (NIPPV) & WHEN TO INTUBATE from a chapter titled Critical Care authored by Shyoko Honiden, MD & Mark D Siegel, MD Yale University School of Medicine from Baliga's Textbook of Internal Medicine www.MasterMedFacts.com Not Medical Advice or Opinion

APPROACH TO VENTILATOR WEANING from a chapter titled Critical Care authored by Shyoko Honiden, MD & Mark D Siegel, MD Yale University School of Medicine from Baliga's Textbook of Internal Medicine www.MasterMedFacts.com Not Medical Advice or Opinion

BASICS OF MECHANICAL VENTILATION from a chapter titled Critical Care in Baliga's Textbook of Internal Medicine www.MasterMedFacts.com authored by Shyoko Honiden, MD & Mark D Siegel, MD Yale University School of Medicine   Not Medical Advice or Opinion

This episode takes us back to the basics of COPD pathophysiology and treatment. Dr. Dickson and Dr. Patrick start with the differential diagnosis of wheezing and move through the escalating COPD treatment options. We then close with a review of common abnormal breath sounds and set the stage for COPD Part 2 which will be coming soon. References: 1. http://citeseerx.ist.psu.edu/viewdoc/download doi=10.1.1.624.2777&rep=rep1&type=pdf 2. Ram, et al. NIPPV for treatment of respiratory failure due to exacerbations of COPD. Cochrane Database Syst. Rev. 2004 3. https://www.easyauscultation.com/lung-sounds

Listen as Dr. Umakanth Katwa, Director of the Sleep Laboratory at Boston Children's Hospital, discusses the use of non-invasive positive pressure ventilation for the treatment of sleep apnea and dysregulated breathing in children. Initial publication: April 23, 2019. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.

Listen as Dr. Dennis Rosen discusses the management of non-invasive positive pressure ventilation in the home setting. Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user.For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

Podcast summary of articles from the October 2018 edition of Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include intranasal vasoconstrictors, pre-oxygenation with NIPPV and nasal cannula, cardiac glycoside toxicity, age adjusted D-dimer for pulmonary embolism, antibiotic use after abscess drainage, and board review on immune checkpoint inhibitor toxicities.  Guest speaker is Dr. Matthew Addis.

What is SCAPE? For this podcast, we're discussing the acute pulmonary edema presentation. This patient is hypertensive (SBP >140mmHg), severely dyspneic, with diffuse rales and clearly anxious. The "no-shitter, drowning-before-your-very-eyes" type of pulmonary edema.  This is the SCAPE patient. SCAPE = Sympathetic Crashing Acute Pulmonary Edema. Patho Quick Hits The core causative factor in the SCAPE patient is an acute increase in left ventricular filling pressure. There are a myriad of causes for a sudden increase in LV pressure, but the end result is a redistribution of fluid into the lungs. 1) Acute increase in LV filling pressure. 2) Fluid redistribution into the lungs and alveolar space. 3) Hypoxia ensues. 4) Catecholamine production and increase in SVR. 5) Activation of the RAAS. It's important to remember that the majority of these patients are not volume overloaded. This is a fluid distribution problem due to increased LV pressure. As the RV continues to pump fluid into the pulmonary circulation, the LV cannot move that fluid forward because of the increased afterload. This creates a pressure gradient that transmits that pressure back into the pulmonary capillaries. 5 Major Causes of SCAPE - Exacerbation of chronic LV failure - Acute myocardial ischemia or infarction involving 25% or more of the myocardial mass - Severe systemic hypertension - Left sided valvular disorders - Acute tachydysrhythmias and bradysrhythmias Treatment In the out of hospital realm, the core treatments are Non Invasive Positive Pressure Ventilation (NIPPV) via CPAP or BiPAP, coupled with nitroglycerine as a first-line medication. For the "regular guy" toolbox, the treatment pathway looks a little like this: 1) Treating the underlying cause if evident. 2) NIPPV 3) NTG 4) More NTG 5) More NTG 6) More NTG  Do not delay NIPPV to see if other therapies (like a NRB) will work first. In the awake patient maintaining their own airway presenting with SCAPE, have a low threshold to apply your NIPPV mode of choice. These patients need PEEP: they generally have an oxygenation problem, and not a ventilation problem. To that point, most prehospital disposable CPAP systems do not deliver 100% FiO2. The O_two and Pulmodyne O2-MAX systems we generally use are either fixed FiO2 or provide a titration of FiO2 based on oxygen flow. The O_two system will provide between 59% and 77% FiO2 at oxygen flow rates between 8L/min and 25 L/min respectively. The Pulmodyne O2-MAX system provides 30% FiO2 regardless of PEEP, or with an additional adapter may provide 30%, 60%, or 90% FiO2 independent of the set PEEP. Nitrogylcerin If sublingual NTG is all you have, give it. Often, too. Lifting up the CPAP mask for 20 seconds is highly unlikely to cause clinically relevant harm. If you have the option of IV NTG, that should be your go-to. Standard dosing strategies for IV NTG of 5-40mcg/min are likely ineffective, and there is literature to support higher dosing strategies. Consider that we bolus 400mcg of SL NTG, and that the bioequivalence of SL NTG is comparable to around an IV NTG dose of 60-80mcg/min, so rapid titration of IV NTG even up to 100mcg/min is not entirely unreasonable and largely supported by current literature. Bibliography Dec, G. W. (2007). Management of Acute Decompensated Heart Failure. Current Problems in Cardiology, 32(6), 321–366. https://doi.org/10.1016/j.cpcardiol.2007.02.002 Mosesso, V. N. J., Dunford, J., Blackwell, T., & Griswell, J. K. (2003). Prehospital therapy for acute congestive heart failure: state of the art. Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 7(1), 13–23. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med4&NEWS=N&AN=12540139 Aguilar, S., Lee, J., Castillo, E., Lam, B., Choy, J., Patel, E., … Serra, J. (2013). Assessment of the addition of prehospital continuous positive airway pressure (CPAP) to an urban emergency medical services (EMS) system in persons with severe respiratory distress. The Journal of Emergency Medicine, 45(2), 210–9. https://doi.org/10.1016/j.jemermed.2013.01.044 Levy, P., Compton, S., Welch, R., Delgado, G., Jennett, A., Penugonda, N., … Zalenski, R. (2007). Treatment of Severe Decompensated Heart Failure With High-Dose Intravenous Nitroglycerin: A Feasibility and Outcome Analysis. Annals of Emergency Medicine, 50(2), 144–152. https://doi.org/10.1016/j.annemergmed.2007.02.022 Mebazaa, A., Gheorghiade, M., Piña, I. L., Harjola, V.-P., Hollenberg, S. M., Follath, F., … Filippatos, G. (2008). Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes. Critical Care Medicine, 36(Suppl), S129–S139. https://doi.org/10.1097/01.CCM.0000296274.51933.4C Agrawal, N., Kumar, A., Aggarwal, P., & Jamshed, N. (2016). Sympathetic crashing acute pulmonary edema. Indian Journal of Critical Care Medicine, 20(12), 719. https://doi.org/10.4103/0972-5229.195710 Mattu, A., Martinez, J. P., & Kelly, B. S. (2005). Modern management of cardiogenic pulmonary edema. Emergency Medicine Clinics of North America. https://doi.org/10.1016/j.emc.2005.07.005 Scott Weingart. EMCrit Podcast 1 – Sympathetic Crashing Acute Pulmonary Edema (SCAPE). EMCrit Blog. Published on April 25, 2009. Accessed on September 11th 2018. Available at [https://emcrit.org/emcrit/scape/ ].

August Quick Summary August Podcast Articles   ED patients with low acuity patients in ambulances, Epi in OHCA, Patients presenting with elevated BP, Biphasic anaphylaxis, The word 'quiet' ?, Probiotics and C. diff, Spinal Motion Restriction in the trauma patient, Bup vs clonidine, Outpatient PE management, NIPPV for COPD, POCT in the ED, and Management of Hyperkalemia

This episode covers Chapter 81 of Rosen’s Emergency Medicine. This one is mint! Heart failure is one of those must-know-about presentations, you WILL see this in the ED.   Define Cardiac index Preload Afterload Describe: How compliance changes the relationship between end diastolic pressures and volume the Frank-Starling relationship Pousseils Law and LaPlaces Law List 3 CV and 4 Neurohormonal physiologic compensatory mechanisms in CHF List the 5 most common disease processes resulting in HF and briefly describe the contribution of each Describe the different classifications of heart failure: Acute vs. Chronic HF Systolic vs. Diastolic dysfunction Right vs. Left sided HF High-output vs. Low-output HF Describe the NYHA function HF Classes and the Killip Classification List 10 common precipitants of acute HF List 6 historical predictors of acute HF and 6 clinical features of acute HF List 5 CXR and 5 ECG findings of HF What is the role of BNP in HF? Describe the primary management goals in acute HF Describe the mechanism of action of NIPPV in HF. Who needs to be intubated? When is it contraindicated? Describe the pharmacologic treatment strategy for: Acute pulmonary edema + adequate perfusion Acute pulmonary edema + hypotension How do nitrates work in acute pulmonary edema? What is the dose? List 10 treatment options for chronic HF

This episode covers Chapter 81 of Rosen’s Emergency Medicine. This one is mint! Heart failure is one of those must-know-about presentations, you WILL see this in the ED.   Define Cardiac index Preload Afterload Describe: How compliance changes the relationship between end diastolic pressures and volume the Frank-Starling relationship Pousseils Law and LaPlaces Law List 3 CV and 4 Neurohormonal physiologic compensatory mechanisms in CHF List the 5 most common disease processes resulting in HF and briefly describe the contribution of each Describe the different classifications of heart failure: Acute vs. Chronic HF Systolic vs. Diastolic dysfunction Right vs. Left sided HF High-output vs. Low-output HF Describe the NYHA function HF Classes and the Killip Classification List 10 common precipitants of acute HF List 6 historical predictors of acute HF and 6 clinical features of acute HF List 5 CXR and 5 ECG findings of HF What is the role of BNP in HF? Describe the primary management goals in acute HF Describe the mechanism of action of NIPPV in HF. Who needs to be intubated? When is it contraindicated? Describe the pharmacologic treatment strategy for: Acute pulmonary edema + adequate perfusion Acute pulmonary edema + hypotension How do nitrates work in acute pulmonary edema? What is the dose? List 10 treatment options for chronic HF

This episode covers Chapter 74 of Rosen’s Emergency Medicine. As Vanilla is to chocolate, COPD is to Asthma. Look for all things wheez-e-y here. Define acute exacerbation Describe GOLD classification for COPD List factors of decompensation or triggers of an AECOPD Name 4 mimics for AECOPD What are the clinical features used to diagnose AECOPD? Describe the ED management of AECOPD. What does the end tidal tracing look like in COPD? List indications and contraindications to NIPPV in COPD Which patients with AECOPD should be treated with antibiotics? Which patients with AECOPD require admission? List indications for intubation for AECOPD   Wise Cracks List 4 CXR and 3 ECG findings in COPD  

This episode covers Chapter 74 of Rosen’s Emergency Medicine. As Vanilla is to chocolate, COPD is to Asthma. Look for all things wheez-e-y here. Define acute exacerbation Describe GOLD classification for COPD List factors of decompensation or triggers of an AECOPD Name 4 mimics for AECOPD What are the clinical features used to diagnose AECOPD? Describe the ED management of AECOPD. What does the end tidal tracing look like in COPD? List indications and contraindications to NIPPV in COPD Which patients with AECOPD should be treated with antibiotics? Which patients with AECOPD require admission? List indications for intubation for AECOPD   Wise Cracks List 4 CXR and 3 ECG findings in COPD  

Through a case discussion, Dr. Calvin Brown III introduces the latest published airway research and discusses its impact on clinical practice.

In this EM Cases episode on Pediatric Asthma we discuss risk stratification (including the PASS and PRAM scores), indications for CXR, the value of blood gases, MDIs with spacer vs nebulizers for salbutamol and ipatropium bromide, the best way to give corticosteroids, the value of inhaled steroids, the importance of early administration of magnesium sulphate in the sickest kids, and the controversies around the use of ketamine, heliox, high flow nasal cannuala oxygen, NIPPV, epinephrine and IV salbutamol in severe asthma exacerbations. So, with the multinational and extensive experience of Dr. Dennis Scolnik, the clinical fellowship Program Director at The Hospital for Sick Children in Toronto and Dr. Sanjay Mehta, multiple award winning educator who you might remember from his fantastic work on our Pediatric Orthopedics episode, we'll help you become more comfortable the next time you are faced with a child with asthma who is crashing in your ED... The post Episode 79 – Management of Acute Pediatric Asthma Exacerbations appeared first on Emergency Medicine Cases.

In this EM Cases episode on Pediatric Asthma we discuss risk stratification (including the PASS and PRAM scores), indications for CXR, the value of blood gases, MDIs with spacer vs nebulizers for salbutamol and ipatropium bromide, the best way to give corticosteroids, the value of inhaled steroids, the importance of early administration of magnesium sulphate in the sickest kids, and the controversies around the use of ketamine, heliox, high flow nasal cannuala oxygen, NIPPV, epinephrine and IV salbutamol in severe asthma exacerbations. So, with the multinational and extensive experience of Dr. Dennis Scolnik, the clinical fellowship Program Director at The Hospital for Sick Children in Toronto and Dr. Sanjay Mehta, multiple award winning educator who you might remember from his fantastic work on our Pediatric Orthopedics episode, we'll help you become more comfortable the next time you are faced with a child with asthma who is crashing in your ED... The post Episode 79 – Management of Acute Pediatric Asthma Exacerbations appeared first on Emergency Medicine Cases.

Pearls from our weekly conference discussing severe asthma and COPD exacerbations. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_17_0_Final.m4a Download 4 Comments Tags: Asthma, BPAP, COPD, NIPPV, Respiratory Show Notes Shownotes EMCrit: Delayed Sequence Intubation REBEL EM: The Crashing Asthmatic EM:RAP: The Rule of 2s Abdo WF, Heunks LM. Oxygen-induced hypercapnia in COPD: myths and facts. Critical Care 16(5):323. PMID: 23106947 Read More

Pearls from our weekly conference discussing severe asthma and COPD exacerbations. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_17_0_Final.m4a Download 4 Comments Tags: Asthma, BPAP, COPD, NIPPV, Respiratory Show Notes Shownotes EMCrit: Delayed Sequence Intubation REBEL EM: The Crashing Asthmatic EM:RAP: The Rule of 2s Abdo WF, Heunks LM. Oxygen-induced hypercapnia in COPD: myths and facts. Critical Care 16(5):323. PMID: 23106947 Read More

Pearls from our weekly conference discussing severe asthma and COPD exacerbations. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_17_0_Final.m4a Download 4 Comments Tags: Asthma, BPAP, COPD, NIPPV, Respiratory Show Notes Shownotes EMCrit: Delayed Sequence Intubation REBEL EM: The Crashing Asthmatic EM:RAP: The Rule of 2s Abdo WF, Heunks LM. Oxygen-induced hypercapnia in COPD: myths and facts. Critical Care 16(5):323. PMID: 23106947 Read More

In this episode of The FlightBridgeED Podcast, Eric outlines the application guidelines and strategies for effective non-invasive positive pressure ventilation. Sometimes putting down the blade, and picking up the mask is an essential step in revolutionary patient care.

In this episode of The FlightBridgeED Podcast, Eric outlines the application guidelines and strategies for effective non-invasive positive pressure ventilation. Sometimes putting down the blade, and picking up the mask is an essential step in revolutionary patient care.See omnystudio.com/listener for privacy information.