PEEP zero. Is this the answer?

Originally posted on MEDEST:

Inspiring discussion on Twitter (Minh Le Cong@rfdsdoc, Karim Brohi @karimbrohi and Peter Sherren@PBSherren)
The topic:
Your hypotensive blunt/penetrating trauma patient with associated severe TBI needs a vent. How do you set it and how you achive your physiological goals?
Is it possible to mantain eucapnia, avoiding hypercapnic insult to the brain, using low minute ventilation strategy and not depressing stroke volume with high intrathoracic pressure?
“Permissive hypoventilation” in a swine model of hemorrhagic shock.

Conclusions: Although permissive hypoventilation leads to respiratory acidosis, it results in less hemodynamic suppression and better perfusion of vital organs. In severely injured penetrating trauma patients, consideration should be given to immediate transportation without PPV.

But what if we have concomitant severe TBI? How can we avoid respiratory acidosis and hypercapnia (due to hypoventilation) and conseguent insult to the brain?

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PHARM PODCAST 101 : ED sedation -towards best practice



Hi Folks

On today’s show, we have Dr Reuben Strayer of EMergency Medicine Updates, Dr Nicholas Chrimes of ClinicalCred and Dr Andy Buck of EDExam discuss and debate the topic of best practice in ED procedural sedation. Nick argues the concerns of aspiration risk in emergency patients with likely full stomachs. Reuben discusses the ED literature around safety of procedural sedation as well as his best practice approach. Andy provides some clinical context with examples from his own ED work.

What do you do in the ED for procedural sedation? Do you think RSI is safer? Do you think ED sedation without RSI is safer? Post your comments!

Show notes:


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Filed under: Emergency medicine and critical care, FOAMEd, Interviews of interesting people, prehospital and retrieval medicine podcast Tagged: ED-sedation, itunes