EM:RAP and AIR (Trauma) (May 2020)
AIR: https://www.aliemu.com/courses/toxicology-2020/
EM:RAP for Asynchronous Learning! For credit, first, listen to the entire podcast. Your participation in the discussion board here is your attestation that you have listened and engaged with the content in a meaningful way.
https://www.emrap.org/episode/emrap2020june/cardiology
When you have finished listening to the podcast, answer the following questions:
1. Please list three things you learned from this podcast that you were not aware of before.
2. Are there any areas of your practice that you would change after listening to this podcast? If so, what would you do differently?
3. What topics mentioned in this podcast is considered too “bleeding edge” (ex. too new, lacks enough evidence, not ready for prime time). Are there any practices mentioned in this podcast that you would consider to not be applicable to our practice setting here at BMC?
3 comments
Please list three things you learned from this podcast that you were not aware of before.
Even in triple lumen catheters there’s a high probability of mixing so we should not give incompatible medications through the triple lumen catheter.
RV wall thickness greater than 0.5 cm, it is indicative of a chronic right heart enlargement.
Periodic breathing with pauses less than 10 seconds is normal in newborns. Pauses greater than 20 seconds, especially if a concomitant infection like bronchiolitis, are concerning.
2. Are there any areas of your practice that you would change after listening to this podcast? If so, what would you do differently?
In the trauma room I often see our nursing colleagues turn to our pharmacist inquiring about which medications can run through which lines. I really enjoyed the segment on lactated ringers. I didn’t know that ceftriaxone can’t be given along with lactated Ringer’s in children under 28 days of age even if administered through two separate lines. I took note of the medications that cannot run through the same line as lactated ringers and will make sure that my patients have two points of access before leaving the trauma room if we’re planning on using LR.
3. What topics mentioned in this podcast is considered too “bleeding edge” (ex. too new, lacks enough evidence, not ready for prime time). Are there any practices mentioned in this podcast that you would consider to not be applicable to our practice setting here at BMC?
I really enjoyed the segment on post-CT LP and CTAs after 6 hours. I now have a better understand of the limitations of the data surrounding the use of CTAs to rule out a SAH. Fortunately at BMC, one of the members of the team can peel off to go perform the LP since we have enough residents (including the procedure resident). I will definitely keep this information in mind but for now we can keep performing LPs after 6 hours for patient who come in with a headache concerning for SAH.
I agree with Regi’s point above about the triple lumen. This came as a bit of a surprise to me – I think I cluelessly thought that once you have a nice big line in, you can just dump whatever you want but I hadn’t thought about the possibility of mixing downstream. This will change my practice, in that patients would benefit from multiple triple lumens (bilateral IJs). I enjoyed the Scott Weingart segment on hand washing, as I agree with many of his points. At times it feels like we are being counseled on hand washing when not practical. I admit I routinely put on gloves because its faster and easier than continuously washing your hands. I love the notion of really emphasizing the importance in the procedural setting. I found the segment on RV dilation in cardiac arrest to be very informative – it makes sense that just identifying RV dilation should not necessarily point us towards PE given the other causes (especially in the arrest setting). I can’t say I have looked for a DVT mid-code, but perhaps will try this if I have strong suspicion for thromboembolic etiology.
1. The information about implementation of high sensitivity troponin was interesting; I admittedly don’t know much about that or have read up on it much since we don’t have it at BMC or other other facilities at which we rotate. Like Regi and Andy, I thought the bit about central line ports being close together may have similar effects as mixing within a single line was interesting. Also, I have been aware of incompatibilities between LR and CTX and blood products for a while, but was unaware of the others. It was also good to hear that the lack of negative interactions with plasmalyte may just be because it hasn’t been studied as well. For now, I’ll still with NS or plasmalyte while resuscitating patients.
2. I’ll definitely be more aware of what medications are going through multi-lumen catheters in the future. I will also be more cognizant of pediatric rashes as I will be seeing a lot of kids at my new job!
3. I think the alternate dispositions for 911 calls is not ready for rollout in most systems. There needs to be a lot of coordination between various social and outpatient services in addition to increased training for EMS personnel who should not be expected to always be able to determine who can safely be transported to somewhere other than an emergency department. It’s a great idea, though, and I’m sure this type of program will become more common over time.