Brought to you by: Priya Ghelani and Maninder Singh
Lightning Injuries and Drowning (Dr. Williams)
– Voltage: High (>100 V) versus low (<100 V)
– High tension power lines are 100K voltage.
– Lightning strikes: high voltage, low time and take path of least resistance. For these, do the reverse of disaster triage (i.e. asystole/VF, or a primary respiratory arrest have good outcomes so do not black tag these patients!)
– Burns do not predict path of current
– For more on electrical injuries, check out our post: https://emrounds.org/
– For more on drowning, check out our post: https://emrounds.org/drowning/
Ventilator Workshop (Dr. Santavicca and Dr. Serrano)
– Slide Show: Mechanical Ventilator Lecture
– Goals of oxygenation (PEEP, FiO2): SpO2 88-95%, PaO2 55-80 mmHg, FiO2<60%
– Goals of ventilation (TV, RR): TV 6-8cc/kg idea body weight and pH 7.25-7.3
– Goal Peak plateu pressure <30 cm H20
– If peak inspiratory pressure > peak plateau pressure, think resistance/obstruction issue
– If peak inspiratory pressure = peak plateau pressure, think stiffness/compliance issue
– Compliance: change in volume/change in pressure
– Increased compliance – COPD; Decreased compliance – ARDS
– CPAP vs BIPAP: setting a pressure (PEEP) vs PEEP + inspiratory pressure
– Volume AC: pay attention to peaks and plateau pressures (since you set TV and flow only)
– Pressure control: pay attention to TV and I:E ratio (since you set PIP and Pplat)
– PRVC: harmful when there is dysynchrony/agitated (since patient is doing more work)