Asthma and the Vent

                                                              TOP  =  AUTO PEEP        BOTTOM  =  NORMAL FLOW

                                                              TOP  =  AUTO PEEP        BOTTOM  =  NORMAL FLOW

Set the Vent in SIMV at 7cc/kg and an I:E ratio of 1:4/1:5 and check a blood gas!
— Andrew Sloas, DO, RDMS, FAAEM

Wow!  We've made it to the end of three episodes on asthma.  We've covered everything from diagnosis to treatment and everything in between.  We now know how to best educate our patients to empower them to treat their disease at home and prevent recitivism! 

Tune in this episode for the specifics on how to use a Peak Flow Meter, Bi-Pap, EtCO2 and of course how to set-up the ventilator in a way to maximize support and minimize chances of injury in your asthmatics. 

EM Crit - Infamous Awake Sedated Video

EM Crit - Dominating the Vent Part 1

EM Crit - Dominating the Vent Part 2

PEFchild1.gif

Asthma Andrews Style – What’s the best oral steroid you ask?

 

What's the best oral steroid to treat acute asthma exacerbations you may ask? Well, we're here to answer that for you.  Please welcome Dr. Annie Andrews, MD, MSCR who has written all the articles you will find listed below on just that subject.  In this podcast we will prove that dexamethasone is not only the most cost effective steroid to prescribe in asthma exacerbations, decreases recidivism, and has the best compliance rates, but it tastes great too! 

http://www.paramedictorn.org/trauma-care.html

Andrews AL, Simpson AN. Dexamethasone may be a viable alternative to
prednisone/prednisolone for the treatment of acute asthma exacerbation in the
paediatric emergency department. Evid Based Med. 2014 Jun 10. pii:
ebmed-2014-110006. doi: 10.1136/eb-2014-110006. [Epub ahead of print] PubMed
PMID: 24919976.

Andrews AL, Wong KA, Heine D, Scott Russell W. A cost-effectiveness analysis
of dexamethasone versus prednisone in pediatric acute asthma exacerbations. Acad
Emerg Med. 2012 Aug;19(8):943-8. doi: 10.1111/j.1553-2712.2012.01418.x. Epub 2012
Jul 31. PubMed PMID: 22849379.


Andrews AL, Teufel RJ, 2nd, Basco WT, Jr., Simpson KN. A Cost-Effectiveness Analysis of Inhaled Corticosteroid Delivery for Children with Asthma in the Emergency Department. Journal of Pediatrics. 2012 Nov;161(5):903-907

Keeney GE, Gray MP, Morrison AK, Levas MN, Kessler EA, Hill GD, Gorelick MH, Jackson JL. Dexamethasone for acute asthma exacerbations in children: a meta-analysis. Pediatrics. 2014 Mar;133(3):493-9. doi: 10.1542/peds.2013-2273. Epub 2014 Feb 10. Review. PubMed PMID: 24515516; PubMed Central PMCID: PMC3934336.

Asthma Andrews Style – What’s the best oral steroid you ask?

 

What's the best oral steroid to treat acute asthma exacerbations you may ask? Well, we're here to answer that for you.  Please welcome Dr. Annie Andrews, MD, MSCR who has written all the articles you will find listed below on just that subject.  In this podcast we will prove that dexamethasone is not only the most cost effective steroid to prescribe in asthma exacerbations, decreases recidivism, and has the best compliance rates, but it tastes great too! 

http://www.paramedictorn.org/trauma-care.html

Andrews AL, Simpson AN. Dexamethasone may be a viable alternative to
prednisone/prednisolone for the treatment of acute asthma exacerbation in the
paediatric emergency department. Evid Based Med. 2014 Jun 10. pii:
ebmed-2014-110006. doi: 10.1136/eb-2014-110006. [Epub ahead of print] PubMed
PMID: 24919976.

Andrews AL, Wong KA, Heine D, Scott Russell W. A cost-effectiveness analysis
of dexamethasone versus prednisone in pediatric acute asthma exacerbations. Acad
Emerg Med. 2012 Aug;19(8):943-8. doi: 10.1111/j.1553-2712.2012.01418.x. Epub 2012
Jul 31. PubMed PMID: 22849379.


Andrews AL, Teufel RJ, 2nd, Basco WT, Jr., Simpson KN. A Cost-Effectiveness Analysis of Inhaled Corticosteroid Delivery for Children with Asthma in the Emergency Department. Journal of Pediatrics. 2012 Nov;161(5):903-907

Keeney GE, Gray MP, Morrison AK, Levas MN, Kessler EA, Hill GD, Gorelick MH, Jackson JL. Dexamethasone for acute asthma exacerbations in children: a meta-analysis. Pediatrics. 2014 Mar;133(3):493-9. doi: 10.1542/peds.2013-2273. Epub 2014 Feb 10. Review. PubMed PMID: 24515516; PubMed Central PMCID: PMC3934336.

Podcast 25 ~ Asthma and Steroids

Asthma…The Music Of The Night

 

In this episode, the first of a three part series on asthma, we will cover the diagnostic and treatment strategies that will help you rapidly move patients through your ED.  No, of course you don't need the patient's asthma classification, but you DO NEED to understand which patients need more treatment and when it's OK to stop.  I will break that all down for you with the aid of the algorithm above.  We'll talk in depth about who can go home safely and who should be in the Unit! Download the flow sheet from the link above, put it in your smart-phone so you have it for your next asthma encounter, and follow along.  It's going to get musical..

Rich Levitan's Yellowstone Advanced Airway Critical Care Course

 

 

 

 

Cabo CME Course - Levitan, Weingart, Matt & Mike, Orman, and Sloas

 

Podcast 24 ~ Asthma.. The Music Of The Night

Asthma…The Music Of The Night

 

In this episode, the first of a three part series on asthma, we will cover the diagnostic and treatment strategies that will help you rapidly move patients through your ED.  No, of course you don't need the patient's asthma classification, but you DO NEED to understand which patients need more treatment and when it's OK to stop.  I will break that all down for you with the aid of the algorithm above.  We'll talk in depth about who can go home safely and who should be in the Unit! Download the flow sheet from the link above, put it in your smart-phone so you have it for your next asthma encounter, and follow along.  It's going to get musical..

Rich Levitan's Yellowstone Advanced Airway Critical Care Course

 

 

 

 

Cabo CME Course - Levitan, Weingart, Matt & Mike, Orman, and Sloas

 

Anyone Seen My Corn? Pediatric Foreign Bodies

THE DERMA-Q

 

How many times have you seen a square object inserted into a round hole.....of an ear canal???  It's quite a quandary and can be the source of frustration for both you and the patient.  You may end up waiting two to three hours just to be able to sedate the little bugger because they have usually just choked down a cheese burger and fries (if your in Britain it may be bangers and mash, Australia a vegemite sandwich, Russia borscht, etc, etc) and then even after you have them sedated, you don't have the right tool to get the foreign body out because the right tool was never created… that is, until now!  Thanks to Dr. David DeLemos from the Texas Children's Pediatric Emergency Medicine program, we now have the solution to the round (or square) object in the ear canal. Let me be the first to introduce you to the "Derma-Q."  The Derma-Q is a contraption created from the plunger of a small syringe or a Q-tip, which has then been tipped (like a tribal dart) with a minute amount of Dermabond.  The Derma-Q provides the perfect rescue technique to get those tough foreign bodies out of almost any orifice. Also making her debut this month on the PEM ED Podcast, my wife, Dr. Holly Sparks will risk life, limb, and my ear canal by getting a cheap piece of plastic jewelry out of my EAC for your viewing pleasure.

Rich Levitan's Yellowstone Advanced Airway Critical Care Course

 

 

 

 

Cabo CME Course - Levitan, Weingart, Matt & Mike, Orman, and Sloas