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MDCast w/ Dr. Michael Lauria - Maternal Cardiac Arrest Aug 13, 2023

Show notes

This is the second of a special podcast series on obstetric critical care. I am joined on this series by Dr. Elizabeth Garchar, MD, FACOG. She is an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a particular interest in obstetric critical care. She is also unique in that she flies regularly with our critical care transport teams and acts as one of our Assistant Medical Directors for the flight program. So, Dr. Garchar has unique insight into managing this population in transport.
The topic of this podcast is maternal cardiac arrest. This is, possibly, one of the most stressful clinical encounters we can have as flight crew. Critical care transport crews are masters of ACLS and resuscitation during cardiac arrest, but what do you do if the patient is pregnant? Often crews have questions: Can we use the same drugs? Do you change the dose of different ACLS drugs? Can you defibrillate a pregnant patient? Do we change hand position for chest compression? In this podcast, Dr. Garchar and I go over the recommendations and guidelines from major organizations and clarify some of these important questions.
References
1. Beckett VA, Knight M, Sharpe P. The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study. BJOG. Aug 2017;124(9):1374-1381. doi:10.1111/1471-0528.14521
2. Bennett TA, Katz VL, Zelop CM. Cardiac Arrest and Resuscitation Unique to Pregnancy. Obstet Gynecol Clin North Am. Dec 2016;43(4):809-819. doi:10.1016/j.ogc.2016.07.011
3. Biderman P, Carmi U, Setton E, Fainblut M, Bachar O, Einav S. Maternal Salvage With Extracorporeal Life Support: Lessons Learned in a Single Center. Anesth Analg. Oct 2017;125(4):1275-1280. doi:10.1213/ANE.0000000000002262
4. Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol. Nov 2012;120(5):1029-36. doi:10.1097/aog.0b013e31826d60c5
5. Campbell TA, Sanson TG. Cardiac arrest and pregnancy. J Emerg Trauma Shock. Jan 2009;2(1):34-42. doi:10.4103/0974-2700.43586
6. Dijkman A, Huisman CM, Smit M, et al. Cardiac arrest in pregnancy: increasing use of perimortem caesarean section due to emergency skills training? BJOG. Feb 2010;117(3):282-7. doi:10.1111/j.1471-0528.2009.02461.x
7. Ducloy-Bouthors AS, Gonzalez-Estevez M, Constans B, Turbelin A, Barre-Drouard C. Cardiovascular emergencies and cardiac arrest in a pregnant woman. Anaesth Crit Care Pain Med. Oct 2016;35 Suppl 1:S43-S50. doi:10.1016/j.accpm.2016.06.008
8. Einav S, Kaufman N, Sela HY. Maternal cardiac arrest and perimortem caesarean delivery: evidence or expert-based? Resuscitation. Oct 2012;83(10):1191-200. doi:10.1016/j.resuscitation.2012.05.005
9. Enomoto N, Yamashita T, Furuta M, et al. Effect of maternal positioning during cardiopulmonary resuscitation: a systematic review and meta-analyses. BMC Pregnancy Childbirth. Feb 25 2022;22(1):159. doi:10.1186/s12884-021-04334-y
10. Fischer C, Bonnet MP, Girault A, Le Ray C. Update: Focus in-hospital maternal cardiac arrest. J Gynecol Obstet Hum Reprod. May 2019;48(5):309-314. doi:10.1016/j.jogoh.2019.02.007
11. Fisher N, Eisen LA, Bayya JV, et al. Improved performance of maternal-fetal medicine staff after maternal cardiac arrest simulation-based training. Am J Obstet Gynecol. Sep 2011;205(3):239 e1-5. doi:10.1016/j.ajog.2011.06.012
12. Ford ND, DeSisto CL, Galang RR, Kuklina EV, Sperling LS, Ko JY. Cardiac Arrest During Delivery Hospitalization : A Cohort Study. Ann Intern Med. Apr 2023;176(4):472-479. doi:10.7326/M22-2750
13. Helviz Y, Einav S. Maternal cardiac arrest. Curr Opin Anaesthesiol. Jun 2019;32(3):298-306. doi:10.1097/ACO.0000000000000719
14. Jeejeebhoy FM, Morrison LJ. Maternal cardiac arrest: a practical and comprehensive review. Emerg Med Int. 2013;2013:274814. doi:10.1155/2013/274814
15. Jeejeebhoy FM, Zelop CM, Lipman S, et al. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association. Circulation. Nov 3 2015;132(18):1747-73. doi:10.1161/CIR.0000000000000300
16. Jeejeebhoy FM, Zelop CM, Windrim R, Carvalho JC, Dorian P, Morrison LJ. Management of cardiac arrest in pregnancy: a systematic review. Resuscitation. Jul 2011;82(7):801-9. doi:10.1016/j.resuscitation.2011.01.028
17. Kikuchi J, Deering S. Cardiac arrest in pregnancy. Semin Perinatol. Feb 2018;42(1):33-38. doi:10.1053/j.semperi.2017.11.007
18. Ko RE, Chung CR, Yang JH, et al. Use of extracorporeal membrane oxygenation in postpartum patients with refractory shock or respiratory failure. Sci Rep. Jan 13 2021;11(1):887. doi:10.1038/s41598-020-80423-w
19. Lipman SS, Daniels KI, Carvalho B, et al. Deficits in the provision of cardiopulmonary resuscitation during simulated obstetric crises. Am J Obstet Gynecol. Aug 2010;203(2):179 e1-5. doi:10.1016/j.ajog.2010.02.022
20. Mizuno A, Saito A, Shibata A. You can never be too prepared: ECMO for MCA. Am J Obstet Gynecol. Jan 2019;220(1):122-123. doi:10.1016/j.ajog.2018.09.019
21. Naoum EE, Chalupka A, Haft J, et al. Extracorporeal Life Support in Pregnancy: A Systematic Review. J Am Heart Assoc. Jul 7 2020;9(13):e016072. doi:10.1161/JAHA.119.016072
22. Ong J, Zhang JJY, Lorusso R, MacLaren G, Ramanathan K. Extracorporeal membrane oxygenation in pregnancy and the postpartum period: a systematic review of case reports. Int J Obstet Anesth. Aug 2020;43:106-113. doi:10.1016/j.ijoa.2020.04.004
23. Shields AD, Battistelli JD, Kavanagh LB, Thomson BA, Nielsen PE. A modified Delphi approach to determine current treatment advances for the development of a resuscitation program for maternal cardiac arrest. BMC Emerg Med. Aug 26 2022;22(1):149. doi:10.1186/s12873-022-00704-7
24. Sommerkamp SK, Gibson A. Cardiovascular disasters in pregnancy. Emerg Med Clin North Am. Nov 2012;30(4):949-59. doi:10.1016/j.emc.2012.08.007
25. Stokes N, Kikucki J. Management of Cardiac Arrest in the Pregnant Patient. Curr Treat Options Cardiovasc Med. Jun 19 2018;20(7):57. doi:10.1007/s11936-018-0652-9
26. Webster CM, Smith KA, Manuck TA. Extracorporeal membrane oxygenation in pregnant and postpartum women: a ten-year case series. Am J Obstet Gynecol MFM. May 2020;2(2):100108. doi:10.1016/j.ajogmf.2020.100108
27. Wu Y, Luo J, Chen T, et al. Successful ECMO-assisted open chest cardiopulmonary resuscitation in a postpartum patient with delayed amniotic fluid embolism. Eur J Med Res. Feb 3 2022;27(1):19. doi:10.1186/s40001-021-00628-1
28. Zelop C, Einav S, ...

E228: MDCast w/ Dr. Michael Lauria - Severe Postpartum Hemorrhage Jul 03, 2023

Show notes

This is the first of a special podcast series on obstetric critical care. I am joined on this series by Dr. Elizabeth Garchar, MD, FACOG. She is an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a special interest in obstetric critical care. She is also unique in that she flies regularly with our critical care transport teams and acts as one of our Assistant Medical Directors for the flight program. So, Dr. Garchar has unique insight into managing this population in transport.
This podcast focuses on severe postpartum hemorrhage. We discuss the epidemiology and risk factors as well as the nuances of diagnosis, specifically how blood loss is actually quantified in this setting. We also go through the importance of point-of-care ultrasound to help identify and manage the causes of postpartum hemorrhage. Then, we transition to the discussion of management, focusing on the medical management of uterine atony, and also go over advanced interventions such as uterine packing, balloon tamponade devices, and REBOA. Finally, Dr. Garchar discusses the indication and procedure for emergent hysterectomy as well as the post-procedure management critical care transport crews may have to perform.
References
• Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. Oct 2017;130(4):e168-e186. doi:10.1097/aog.0000000000002351
• Abdel-Aleem H, Singata M, Abdel-Aleem M, Mshweshwe N, Williams X, Hofmeyr GJ. Uterine massage to reduce postpartum hemorrhage after vaginal delivery. Int J Gynaecol Obstet. Oct 2010;111(1):32-6. doi:10.1016/j.ijgo.2010.04.036
• Abul A, Al-Naseem A, Althuwaini A, Al-Muhanna A, Clement NS. Safety and efficacy of intrauterine balloon tamponade vs uterine gauze packing in managing postpartum hemorrhage: A systematic review and meta-analysis. AJOG Glob Rep. Feb 2023;3(1):100135. doi:10.1016/j.xagr.2022.100135
• Aibar L, Aguilar MT, Puertas A, Valverde M. Bakri balloon for the management of postpartum hemorrhage. Acta Obstet Gynecol Scand. Apr 2013;92(4):465-7. doi:10.1111/j.1600-0412.2012.01497.x
• Bagga R, Jain V, Kalra J, Chopra S, Gopalan S. Uterovaginal packing with rolled gauze in postpartum hemorrhage. MedGenMed. Feb 13 2004;6(1):50.
• Borger van der Burg BLS, van Dongen T, Morrison JJ, et al. A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination. Eur J Trauma Emerg Surg. Aug 2018;44(4):535-550. doi:10.1007/s00068-018-0959-y
• Castellini G, Gianola S, Biffi A, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis. World J Emerg Surg. Aug 12 2021;16(1):41. doi:10.1186/s13017-021-00386-9
• Collaborators WT. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. May 27 2017;389(10084):2105-2116. doi:10.1016/S0140-6736(17)30638-4
• Cunningham FG, Nelson DB. Disseminated Intravascular Coagulation Syndromes in Obstetrics. Obstet Gynecol. Nov 2015;126(5):999-1011. doi:10.1097/AOG.0000000000001110
• D'Alton M, Rood K, Simhan H, Goffman D. Profile of the Jada(R) System: the vacuum-induced hemorrhage control device for treating abnormal postpartum uterine bleeding and postpartum hemorrhage. Expert Rev Med Devices. Sep 2021;18(9):849-853. doi:10.1080/17434440.2021.1962288
• Dildy GA, 3rd. Postpartum hemorrhage: new management options. Clin Obstet Gynecol. Jun 2002;45(2):330-44. doi:10.1097/00003081-200206000-00005
• Dueckelmann AM, Hinkson L, Nonnenmacher A, et al. Uterine packing with chitosan-covered gauze compared to balloon tamponade for managing postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol. Sep 2019;240:151-155. doi:10.1016/j.ejogrb.2019.06.003
• Erez O. Disseminated intravascular coagulation in pregnancy: New insights. Thrombosis Update. 2022;6doi:10.1016/j.tru.2021.100083
• Erez O, Mastrolia SA, Thachil J. Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management. Am J Obstet Gynecol. Oct 2015;213(4):452-63. doi:10.1016/j.ajog.2015.03.054
• Erez O, Othman M, Rabinovich A, Leron E, Gotsch F, Thachil J. DIC in Pregnancy - Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments. J Blood Med. 2022;13:21-44. doi:10.2147/JBM.S273047
• Feng S, Liao Z, Huang H. Effect of prophylactic placement of internal iliac artery balloon catheters on outcomes of women with placenta accreta: an impact study. Anaesthesia. Jul 2017;72(7):853-858. doi:10.1111/anae.13895
• Higgins N, Patel SK, Toledo P. Postpartum hemorrhage revisited: new challenges and solutions. Curr Opin Anaesthesiol. Jun 2019;32(3):278-284. doi:10.1097/ACO.0000000000000717
• Ji SM, Cho C, Choi G, et al. Successful management of uncontrolled postpartum hemorrhage due to morbidly adherent placenta with Resuscitative endovascular balloon occlusion of the aorta during emergency cesarean section - A case report. Anesth Pain Med (Seoul). Jul 31 2020;15(3):314-318. doi:10.17085/apm.19051
• Kellie FJ, Wandabwa JN, Mousa HA, Weeks AD. Mechanical and surgical interventions for treating primary postpartum haemorrhage. Cochrane Database Syst Rev. Jul 1 2020;7(7):CD013663. doi:10.1002/14651858.CD013663
• Kogutt BK, Vaught AJ. Postpartum hemorrhage: Blood product management and massive transfusion. Semin Perinatol. Feb 2019;43(1):44-50. doi:10.1053/j.semperi.2018.11.008
• Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. Apr 2009;145(1):24-33. doi:10.1111/j.1365-2141.2009.07600.x
• Liu C, Gao J, Liu J, et al. Predictors of Failed Intrauterine Balloon Tamponade in the Management of Severe Postpartum Hemorrhage. Front Med (Lausanne). 2021;8:656422. doi:10.3389/fmed.2021.656422
• Lohano R, Haq G, Kazi S, Sheikh S. Intrauterine balloon tamponade for the control of postpartum haemorrhage. J Pak Med Assoc. Jan 2016;66(1):22-6.
• Maier RC. Control of postpartum hemorrhage with uterine packing. Am J Obstet Gynecol. Aug 1993;169(2 Pt 1):317-21; discussion 321-3. doi:10.1016/0002-9378(93)90082-t
• Makin J, Suarez-Rebling DI, Varma Shivkumar P, Tarimo V, Burke TF. Innovative Uses of Condom Uterine Balloon Tamponade for Postpartum Hemorrhage in India and Tanzania. Case Rep Obstet Gynecol. 2018;2018:4952048. doi:10.1155/2018/4952048
• Natarajan A, Alaska Pendleton A, Nelson BD, et al. Provider experiences with improvised uterine balloon tamponade for the management of uncontrolled postpartum hemorrhage in Kenya. Int J Gynaecol Obstet. Nov 2016;135(2):210-213. doi:10.1016/j.ijgo.2016.05.006
• Natarajan A, Kamara J, Ahn R, et al. Provider experience of uterine balloon tamponade for the management of postpartum hemorrhage in Sierra Leone. Int J Gynaecol Obstet. Jul 2016;134(1):83-6. doi:10.1016/j.ijgo.2015.10.026
• Okoye HC, Nwagha TU, Ugwu AO, et al. Diagnosis and treatment of bbstetrics disseminated intravascular coagulation in resource limited settings. Afr Health Sci. Mar 2022;22(1):183-190. doi:10.4314/ahs.v22i1.24
• Ordonez CA, Manzano-Nunez R, Parra MW, et al. Prophylactic use of resuscitative endovascular balloon occlusion of the aorta in women with abno...

E227: MDCast: Calcium Administration in the Severely Injured Trauma Patient - Practical Application w/ Dr. Mike Lauria May 15, 2023

Show notes

Calcium administration to trauma patients has become a hot topic with the rise of the “Lethal Diamond." While evidence exists regarding the association between hypocalcemia and mortality, it remains unclear whether hypocalcemia is the problem or simply a finding secondary to critical injury. In this podcast, Dr. Lauria reviews the evidence behind calcium administration in trauma and identifies which patients, given the available evidence, might benefit from calcium administration. Don't miss another FlightBridgeED Podcast feature episode of the MDCast! So much good stuff! Please like, subscribe, and leave any questions or comments.
References for the use of Calcium in Severe Trauma
• Chanthima P, Yuwapattanawong K, Thamjamrassri T, et al. Association Between Ionized Calcium Concentrations During Hemostatic Transfusion and Calcium Treatment With Mortality in Major Trauma. Anesth Analg. Jun 1 2021;132(6):1684-1691. doi:10.1213/ANE.0000000000005431
• D B. Prehospital administration of calcium in trauma J Paramed Prac. 2022;
• DeBot M, Sauaia A, Schaid T, Moore EE. Trauma-induced hypocalcemia. Transfusion. Aug 2022;62 Suppl 1:S274-S280. doi:10.1111/trf.16959
• Ditzel RM, Jr., Anderson JL, Eisenhart WJ, et al. A review of transfusion- and trauma-induced hypocalcemia: Is it time to change the lethal triad to the lethal diamond? J Trauma Acute Care Surg. Mar 2020;88(3):434-439. doi:10.1097/TA.0000000000002570
• Giancarelli A, Birrer KL, Alban RF, Hobbs BP, Liu-DeRyke X. Hypocalcemia in trauma patients receiving massive transfusion. J Surg Res. May 1 2016;202(1):182-7. doi:10.1016/j.jss.2015.12.036
• Kronstedt S, Roberts N, Ditzel R, et al. Hypocalcemia as a predictor of mortality and transfusion. A scoping review of hypocalcemia in trauma and hemostatic resuscitation. Transfusion. Aug 2022;62 Suppl 1(Suppl 1):S158-S166. doi:10.1111/trf.16965
• Leech C, Clarke E. Pre-hospital blood products and calcium replacement protocols in UK critical care services: A survey of current practice. Resusc Plus. Sep 2022;11:100282. doi:10.1016/j.resplu.2022.100282
• Messias Hirano Padrao E, Bustos B, Mahesh A, et al. Calcium use during cardiac arrest: A systematic review. Resusc Plus. Dec 2022;12:100315. doi:10.1016/j.resplu.2022.100315
• Moore HB, Tessmer MT, Moore EE, et al. Forgot calcium? Admission ionized-calcium in two civilian randomized controlled trials of prehospital plasma for traumatic hemorrhagic shock. J Trauma Acute Care Surg. May 2020;88(5):588-596. doi:10.1097/TA.0000000000002614
• Savioli G, Ceresa IF, Caneva L, Gerosa S, Ricevuti G. Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes. Medicines (Basel). Mar 24 2021;8(4)doi:10.3390/medicines8040016
• Steele T, Kolamunnage-Dona R, Downey C, Toh CH, Welters I. Assessment and clinical course of hypocalcemia in critical illness. Crit Care. Jun 4 2013;17(3):R106. doi:10.1186/cc12756
• Stueven H, Thompson BM, Aprahamian C, Darin JC. Use of calcium in prehospital cardiac arrest. Ann Emerg Med. Mar 1983;12(3):136-9. doi:10.1016/s0196-0644(83)80551-4
• Vallentin MF, Granfeldt A, Meilandt C, et al. Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. Dec 14 2021;326(22):2268-2276. doi:10.1001/jama.2021.20929
• Vallentin MF, Povlsen AL, Granfeldt A, Terkelsen CJ, Andersen LW. Effect of calcium in patients with pulseless electrical activity and electrocardiographic characteristics potentially associated with hyperkalemia and ischemia-sub-study of the Calcium for Out-of-hospital Cardiac Arrest (COCA) trial. Resuscitation. Dec 2022;181:150-157. doi:10.1016/j.resuscitation.2022.11.006
• Vasudeva M, Mathew JK, Groombridge C, et al. Hypocalcemia in trauma patients: A systematic review. J Trauma Acute Care Surg. Feb 1 2021;90(2):396-402. doi:10.1097/TA.0000000000003027
• Vettorello M, Altomare M, Spota A, et al. Early Hypocalcemia in Severe Trauma: An Independent Risk Factor for Coagulopathy and Massive Transfusion. J Pers Med. Dec 28 2022;13(1)doi:10.3390/jpm13010063
• Wray JP, Bridwell RE, Schauer SG, et al. The diamond of death: Hypocalcemia in trauma and resuscitation. Am J Emerg Med. Mar 2021;41:104-109. doi:10.1016/j.ajem.2020.12.065
• Zhang Z, Xu X, Ni H, Deng H. Predictive value of ionized calcium in critically ill patients: an analysis of a large clinical database MIMIC II. PLoS One. 2014;9(4):e95204. doi:10.1371/journal.pone.0095204

E226: MDCast: ASA Overdose Rebuttal & Practical Application w/ Dr. Mike Lauria May 03, 2023

Show notes

Join FlightBridgeED's new Chief Medical Director, Mike Lauria, as we launch the FlightBridgeED MDCast. Dr. Lauria will hijack these episodes for a new perspective on current topics in critical care medicine. In this episode, Dr. Lauria looks at Eric's previously published podcast [episode 224] on ASA Overdose and gives his insight, practical application, and overall thoughts on these difficult-to-manage patients. Don't miss this episode! So much good stuff! Please like, subscribe, and leave any questions or comments.
References for Acute Salicylate Intoxication
• Anderson RJ, Potts DE, Gabow PA, Rumack BH, Schrier RW. Unrecognized adult salicylate intoxication. Ann Intern Med. Dec 1976;85(6):745-8. doi:10.7326/0003-4819-85-6-745
• Chyka PA, Erdman AR, Christianson G, et al. Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(2):95-131. doi:10.1080/15563650600907140
• Dargan PI, Wallace CI, Jones AL. An evidence-based flowchart to guide the management of acute salicylate (aspirin) overdose. Emerg Med J. May 2002;19(3):206-9. doi:10.1136/emj.19.3.206
• Delaney TM, Helvey JT, Shiffermiller JF. A Case of Salicylate Toxicity Presenting with Acute Focal Neurologic Deficit in a 61-Year-Old Woman with a History of Stroke. Am J Case Rep. Feb 15 2020;21:e920016. doi:10.12659/AJCR.920016
• Espírito Santo R, Vaz S, Jalles F, Boto L, Abecasis F. Salicylate Intoxication in an Infant: A Case Report. Drug Saf Case Rep. Nov 27 2017;4(1):23. doi:10.1007/s40800-017-0065-9
• Goldberg MA, Barlow CF, Roth LJ. The effects of carbon dioxide on the entry and accumulation of drugs in the central nervous system. J Pharmacol Exp Ther. Mar 1961;131:308-18.
• Juurlink DN, Gosselin S, Kielstein JT, et al. Extracorporeal Treatment for Salicylate Poisoning: Systematic Review and Recommendations From the EXTRIP Workgroup. Ann Emerg Med. Aug 2015;66(2):165-81. doi:10.1016/j.annemergmed.2015.03.031
• Kuzak N, Brubacher JR, Kennedy JR. Reversal of salicylate-induced euglycemic delirium with dextrose. Clin Toxicol (Phila). Jun-Aug 2007;45(5):526-9. doi:10.1080/15563650701365800
• McCabe DJ, Lu JJ. The association of hemodialysis and survival in intubated salicylate-poisoned patients. Am J Emerg Med. Jun 2017;35(6):899-903. doi:10.1016/j.ajem.2017.04.017
• Miyahara JT, Karler R. Effect of salicylate on oxidative phosphorylation and respiration of mitochondrial fragments. Biochem J. Oct 1965;97(1):194-8. doi:10.1042/bj0970194
• Oliver TK, Jr., Dyer ME. The prompt treatment of salicylism with sodium bicarbonate. AMA J Dis Child. May 1960;99:553-65. doi:10.1001/archpedi.1960.02070030555001
• Oualha M, Dupic L, Bastian C, Bergounioux J, Bodemer C, Lesage F. [Local salicylate transcutaneous absorption: an unrecognized risk of severe intoxication: a case report]. Arch Pediatr. Oct 2012;19(10):1089-92. Application cutanée localisée d'acide salicylique : un risque méconnu d'intoxication : à propos d'un cas. doi:10.1016/j.arcped.2012.07.012
• Palmer BF, Clegg DJ. Salicylate Toxicity. N Engl J Med. Jun 25 2020;382(26):2544-2555. doi:10.1056/NEJMra2010852
• Penniall R. The effects of salicylic acid on the respiratory activity of mitochondria. Biochim Biophys Acta. Nov 1958;30(2):247-51. doi:10.1016/0006-3002(58)90047-7
• Shively RM, Hoffman RS, Manini AF. Acute salicylate poisoning: risk factors for severe outcome. Clin Toxicol (Phila). Mar 2017;55(3):175-180. doi:10.1080/15563650.2016.1271127
• Stolbach AI, Hoffman RS, Nelson LS. Mechanical ventilation was associated with acidemia in a case series of salicylate-poisoned patients. Acad Emerg Med. Sep 2008;15(9):866-9. doi:10.1111/j.1553-2712.2008.00205.x
• Thurston JH, Pollock PG, Warren SK, Jones EM. Reduced brain glucose with normal plasma glucose in salicylate poisoning. J Clin Invest. Nov 1970;49(11):2139-45. doi:10.1172/JCI106431

E225: The Resuscitative Mindset: Airway Decision Making w/ Kevin Collopy Apr 23, 2023

Show notes

In this podcast, Eric discusses the art of having a "Resuscitative Mindset" when performing advanced airway management with guest host Kevin Collopy. When is it ok to perform advanced airway management rapidly? Is it ever ok? When do we deploy delayed sequence strategies? Should we always use a "Resuscitative" sequence intubation mindset regardless of our assessment findings? So much good conversation about all things airway and decision-making. Please like, subscribe, and leave any questions or comments.
Contact information for Kevin Collopy
Twitter: @ktcollopy
Email: Kevin.Collopy@novanthealth.org

E224: The Nightmare Patient - ASA Overdose Mar 11, 2023

Show notes

In this podcast, Eric takes a look at a very difficult case of multifactorial resuscitation within ASA overdose. We dive deep into all things resuscitation and analyze factors that drive our decision-making. This takes the "acidosis rodeo podcast series to another level. Don't miss this episode! So much good stuff! Please like, subscribe, and leave any questions or comments.

E223: Hamilton T1 | When To Use Volume Adaptive w/ Joe Hylton Mar 02, 2023

Show notes

Eric is joined by Joe Hylton, a respiratory therapist, flight paramedic, and Hamilton RT, as they dive into all things Volume Control [Adaptive], ASV, and Pressure Control (Biphasic) ventilation. There are many misconceptions and questions answered within this information-packed podcast. We use the Hamilton simulator to show the differences between patients and accompanying interactions while in Volume Control [Adaptive] ventilation. We discuss when it's best to use Pressure Control [Biphasic] over Volume Control [Adaptive] and the hazards associated with this common mistake. We dive into the long-discussed debate of Assist Control vs. SIMV. Lastly, we discuss the topic of ASV and the technology around this method/mode of delivery.
This is an audio version only. For the best experience, we highly recommend watching the full video version. Please visit the YouTube link below or the FlightBridgeED channel.
Episode Link: https://youtu.be/nhlll1hI7XU

E222: “Pandemic Immunity Gap?” - Managing Acute Respiratory Compromise in RSV Feb 14, 2023

Show notes

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.
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Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis
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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
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E221: Culture vs. Risk w/ Miles Dunagan Nov 24, 2022

Show notes

Join Eric and Miles Dunagan, President of the National Pilots Association at AMTC ELEVATE 2022, to discuss Just Culture, safety, risk, past air medical accidents, and much more. Just culture has become the foundation for organizational learning, transparency, and the overall safety initiative within the industry we all serve. The evaluation of risk is always part of our collective jobs. Whether you are a pilot, a paramedic, or a nurse, we have all experienced risk. Risk is always around us. How can risk be mitigated? It starts with open communication, transparency, each team member feeling like they have a voice and a company culture that drives this message from the top down.
Join us for this information-packed podcast highlighting how Just Culture collides with risk, which drives awareness and good decision-making.

E220: Prehospital Hypertonic Saline Administration After Severe Traumatic Brain Injury w/ Kevin Collopy Nov 10, 2022

Show notes

In this episode, Eric is joined by Kevin Collopy at Elevate 2022 to discuss his team's recent research on TBI and 3% hypertonic saline. The conversation quickly progressed to overall resuscitation in TBI, with a focus on decision-making in airway management, ICP management, herniation, and the secondary injuries that impact TBI patients. This is a must-listen, with many great discussion points.
Prehospital Hypertonic Saline Administration After Severe Traumatic Brain Injury
https://doi.org/10.1016/j.amj.2022.04.004
Abstract
"A 25-year-old male patient was critically injured in a high-speed motor vehicle collision over an hour from the nearest trauma center. Paramedics diagnosed the patient with a traumatic brain injury and increased intracranial pressure and transported the patient to a predesignated landing zone for helicopter intercept. During transport, paramedics initiated a severe traumatic brain injury protocol which included the administration of 3% hypertonic saline."

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