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EM doc | Resuscitationist | Medical Educator | EMRAP Managing Editor He/Him/His Instagram: @EMSwami

Anand Swaminathan

Painless Monocular Vision Loss -Dx: CRAO, retinal + post vitreous detachment, vitreous hemorrhage -POCUS: If see eye pathology - you’re done. May see retrobulbar spot sign(diagnostic CRAO) -If don’t see clear eye cause or you’re not sure, default to stroke workup youtube.com/shorts/ZVheS... #EMIMCC

Beta blockade in sepsis? -Early, tachycardia compensatory mechanism to increase CO + perfusion -Persistent tachycardia after resus may indicate exaggerated sympathetic response that can cause cardiac dysfunction youtube.com/shorts/nLmSy... #EMIMCC

Nicardipine: great for htn emergency but, can see transient hypotension even w/ slow titration -Key is to load + drip -Start 5 mg/hr + titrate up 2.5 mg/hr q5 min -When reach target BP, drop dose back to 5 mg/hr + retitrate infusion until get to steady state youtube.com/shorts/2F0-1... #EMIMCC

Airway Plan Verbalization -Going through your primary, secondary + tertiary plans is a key step in preparation -Use “when” not “if” language: communicates to team that challenges and progression to secondary + tertiary approaches expected youtube.com/shorts/vHbB9... #EMIMCC

Hypokalemia is a big killer in DKA: -Total body depleted regardless of serum level (acidosis shifts K from cells) - Above 3.5 can start insulin and K simultaneously - Below 3.5 replete K aggressively before adding insulin youtube.com/shorts/qBmL3... #EMIMCC

Bougie Steering -Bougie use in expert hands improves 1st pass success (PMID 29800096) -Common obstacle is steering the tip -Key: use scissor grip: hold bougie between 3rd + 4th digits. Apply upward force w/ 4th digit using 3rd digit as a fulcrum youtube.com/shorts/2dqYl... #EMIMCC

Phenobarbital a game changer in EtOH w/d -Option 1: No benzos given. Load 10 mg/kg over 30 min + wait 30 min for effect -Option 2: post-escalating BZD. Give phenobarbital 130 mg IV q15 until adequate sedation achieved -Early phenobarbital use can avoid intubation youtube.com/shorts/IMcT7... #EMIMCC

Resuscitate Before you Intubate: BP/Perfusion support -BP will drop w/ induction meds -Vasoactives better than fluids: incr peripheral tone + contractility/cardiac output + improve venous tone -Consider pushing MAP to 75-80 mm Hg (no data) to give extra cushion youtube.com/shorts/ZrDsO... #EMIMCC

14d

11d

16d

Refractory migraine: consider haloperidol/droperidol -Butyrophenones extremely effective in headache + nausea management -Haloperidol 5 mg IV or droperidol 2.5 mg IV rapid acting + safe (PMID: 27510942) -Single dose highly unlikely to have significant QTc effect youtube.com/shorts/KsvE7... #EMIMCC

18d

20d

Haloperidol is a Fantastic Multi-Tasker -Sedation of the agitated patient -Potent antiemetic particularly in gastroparesis (PMID 28320545) + CHS (PMID: 33160719) -Excellent in migraines (PMID 27510942) -Refractory sickle cell disease pain + chronic abdominal pain youtube.com/shorts/A5Ju5... #EMIMCC