We cover pearls from smaccDUB (Social Media and Critical Care Conference in Dublin, Ireland), Day 3. We are here thanks to the Rosh Review.
Dr. Scott Weingart – “Post-Intubation Sedation“
- Analgesia first. Try a hydromorphone 1mg push while you’re waiting for the fentanyl drip. The endotracheal tube is uncomfortable.
- Minimize sedation. There’s this principle: eCASH: early Comfort using Analgesia, minimal Sedatives and maximal Humane care .
- Sedation: go for dexmedetomidine if you have it (but it’s expensive) or propofol. This is supported by the Society of Critical Care Medicine (SCCM) Pain, Agitation, and Delirium guidelines .
- Be careful with rocuronium. The long duration of rocuronium means that you can’t assess for pain or discomfort so you must be responsible and get these
Dr. David Carr – “The Aorta Will #!&?% You Up”
Dr. Kathleen Thomas – “Oh Sh**! They’re bombing the hospital!”
We should not need a website entitled STOPBOMBINGHOSPITALS.ORG but, unfortunately, over the past 4 years, 400 hospitals have been bombed. This passionate, wrenching talk is a “must see” and “must listen” when the free talks are released on the SMACC podcast over the course of the next year.
- Vincent J, Shehabi Y, Walsh TS et al. Comfort and patient-centred care without excessive sedation: the eCASH concept. Intensive Care Med. 42(6):962-971. 2016. [article]
- Barr J, Fraser GL, Puntillo K et al. Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. Critical Care Medicine. 41(1):263-306. 2013. [article]
- Watt JM, Amini A, Traylor BR, Amini R, Sakles JC, Patanwala AE. Effect of paralytic type on time to post-intubation sedative use in the emergency department. Emergency medicine journal : EMJ. 30(11):893-5. 2013. [pubmed]
- Imamura H, Sekiguchi Y, Iwashita T et al. Painless Acute Aortic Dissection. Circ J. 75(1):59-66. 2011. [article]
- Diercks DB, et al. Clinical policy: critical issues in the evaluation and management of adult patients with suspected acute nontraumatic thoracic aortic dissection. Ann Emerg Med. 2015 Jan;65(1):32-42.e12. PMID: 25529153.
- Hagan PG, Nienaber CA, Isselbacher EM. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 283(7):897-903. 2000. [pubmed]