Anti-Aging Creams?
Maybe You Just Need Jelly (Fish)
Meet the ultimate escape artist of the animal kingdom: the Turritopsis dohrnii, a jellyfish smaller than your pinky nail that's basically found nature's fountain of youth. Unlike its mortal cousins who follow the boring old path of birth, life, and death, this tiny troublemaker can pull off the biological equivalent of a video game respawn - when faced with danger or stress, it simply transforms back into its teenage self and starts life over again, like a butterfly reverse-engineering itself back into a caterpillar.
While these miniature immortals might sound like something out of science fiction, they're very real and spreading across the world's oceans, hitching rides in ship ballast water like aquatic stowaways. Japanese scientist Shin Kubota has observed them pulling this age-reversal trick up to 10 times in just two years, though he has to carefully prepare their tiny meals under a microscope - turns out being immortal doesn't make you any less picky about portion sizes.
Welcome to the 101st edition of ResusNation!
Your Hand Positioning is
Sabotaging Your VL Skills
Throughout my years of airway management, I've noticed a common misconception about leveraging rigid stylets during intubation. While many clinicians instinctively grasp the endotracheal tube low, as they would during direct laryngoscopy, this significantly reduces mechanical advantage when using video laryngoscopy. I've found that placing your thumb under the flange at the very top of the tube creates the longest possible lever arm, making it remarkably easier to navigate around the tongue and through the glottis.
My technique involves inserting the blade while watching the patient, then shifting my gaze to the screen once I've lifted the epiglottis into the upper third of the view. With the rigid stylet pointing downward, I maintain that high grip position for optimal control. This approach has transformed difficult airways into manageable ones by maximizing our mechanical advantage – it's a simple physics principle that many of us weren't taught during traditional airway training.
Watch the full video with Dr. Rich Byrne here and leave a comment.
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What is auto-PEEP, and why can it lead to life-threatening complications in ventilated patients? In this episode, Dr. Anozie breaks down the physiology behind auto-PEEP, its dangerous effects like dynamic hyperinflation and cardiovascular instability, and how to spot its subtle signs on ventilator waveforms. With a focus on practical solutions, from adjusting ventilator settings to optimizing PEEP, this episode equips you with the knowledge to protect your patients and save lives. Don’t miss this vital discussion on ventilator management and critical care!
Check out this video of Dr. Anozie from ResusX:ReVolved now!
Watch 75 of Our Best Resus Videos!
Have you managed a crash airway, had to resuscitate with refractroy ventricular tachaycardia, or lead your team during a resuscitation? If you answered yes, then ask yourself, "are you treating your patients with the most cutting-edge and evidence based medicine?" Today you can sign up for ResusX:Select Volume 1,2, and 3. In all, you will get lifetime access to 75 of our very best resuscitation videos so you can take your skills to the next level!
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Check out all 75 videos that you'll get lifetime access to:
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Reducing Hypoxemia During RSI
When critically ill patients need to be intubated, maintaining normoxia is crucial. More than 1.5 million adults undergo this procedure yearly in U.S. hospitals, and hypoxemia occurs in 10-20% of cases. Researchers from multiple U.S. medical centers conducted a large study comparing two methods of giving oxygen before intubation: traditional non-rebreather masks versus noninvasive ventilation (NIV) for positive pressure ventilation.
The study included 1,301 critically ill adults who needed intubation in either the emergency department or ICU. Researchers found that using noninvasive ventilation cut the risk of dangerous oxygen drops nearly in half compared to standard oxygen masks (9.1% versus 18.5% of patients).
A common concern about NIV has been whether it might increase the risk of aspiration of stomach contents. However, the study found this complication occurred at similar low rates with both methods (0.9% with noninvasive ventilation versus 1.4% with oxygen masks). The study also showed that NIV ventilation could be implemented safely in real-world emergency settings.
Here's my Takeaways:
- NIV before intubation reduces the risk of hypoxemia by about 50% compared to standard oxygen masks
- The safety profile was similar between both methods, addressing previous concerns about increased complications
- The benefits of NIV were consistent across different types of patients and medical settings, suggesting it could be widely adopted as a safer standard practice
Want to learn more? Read the full study "Noninvasive Ventilation for Preoxygenation during Emergency Intubation" by Gibbs KW, Semler MW, Driver BE, et al. in The New England Journal of Medicine (2024).
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HTS in the Peripheral IV
Is it safe to administer 3% hypertonic saline through a peripheral IV during a neurologic emergency? In this episode, Dr. Salim Rezaie breaks down the evidence and challenges the need for central lines in time-sensitive cases. Learn why bolusing hypertonic saline through a peripheral line can reduce intracranial pressure more effectively while avoiding delays and central line complications. Packed with data and practical insights, this discussion is essential for anyone managing critical care patients. Don’t miss this thought-provoking episode on advancing emergency medicine!
Check out this video of Dr. Salim Rezaie from ResusX:ReVolved now!
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