Resus Now

On this episode, We discuss some contraindications, controversies, data analysis of different clinical trials of TXA, and much more! Please see links below for referenced articles in the show.

http://www.emra.org/emresident/article/critcare-alert-crash3/

https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-020-04623-5

https://emcrit.org/pulmcrit/crash3/

https://first10em.com/halt-it-trial/

https://www.thebottomline.org.uk/summaries/icm/tich-2/

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31033-X/fulltext

https://www.bmj.com/content/343/bmj.d3795

https://rebelem.com/crash-3-txa-for-ich/

In this 5 minute bit, we describe the mechanism of action of tranexamic acid and its many indications as it applies to emergency conditions. Please see below for articles and evidence related to the show.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023891/

https://pubmed.ncbi.nlm.nih.gov/23477634/

https://emcrit.org/rush-exam/original-rush-article/

https://emcrit.org/wp-content/uploads/2011/03/New-RUSH-Review-Article1.pdf

https://emcrit.org/wp-content/uploads/2011/03/new-rush-study.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3485910/

https://emcrit.org/rush-exam/original-rush-article/

https://emcrit.org/wp-content/uploads/2011/03/New-RUSH-Review-Article1.pdf

https://emcrit.org/wp-content/uploads/2011/03/new-rush-study.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3485910/

In this 5 minute bit, we discuss scenario based pressor selection, vasopressors to choose in the face of RV failure or pulmonary hypertension, and peripheral vasopressors. Below you will find evidence related articles on vasopressin and dobutamine effect on pulmonary vascular resistance, safety profile of peripheral pressors and an interesting article about using midline catheters as an alternative to central lines for vasopressor administration (not prime time yet). 

https://pubmed.ncbi.nlm.nih.gov/12682485/

http://www.emdocs.net/the-crashing-pulmonary-hypertension-patient/

https://emcrit.org/emcrit/peripheral-vasopressors-extravasation/

https://pubmed.ncbi.nlm.nih.gov/26014852/

http://www.emdocs.net/r-e-b-e-l-em-peripheral-pressors-6-pearls-to-not-fk-up-the-arm/

https://journals.lww.com/ccmjournal/fulltext/2020/01001/1276__safety_and_efficacy_of_vasopressor.1232.aspx

https://first10em.com/peripheralperssors/

https://www.acep.org/how-we-serve/sections/critical-care-medicine/news/july-2017/peripherally-versus-centrally-administered-potent-vasopressors-in-the-icu/

https://journals.lww.com/anesthesia-analgesia/fulltext/2002/02000/vasopressin_effect_on_pulmonary_arterial_pressure.59.aspx

In this 5 minute bit we discuss Phenylephrine, Angiotensin II, Dobutamine and Milrinone. Please see attached evidence related to our topic:

*Just to clarify, dobutamine and milrinone can both be used for right ventricular systolic failure but there is some evidence that milrinone may provide better pulmonary vascular afterload reduction than dobutamine.  NO MILRINONE IN RENAL FAILURE.  MILRINONE IS LONG ACTING. 

*Just to clarify, Angiotensin II data was not solely tested against placebo.  The actual randomized trial had both groups on high dose norepinephrine and one group had placebo as a second agent and the other group had angiotensin II as a second agent.  The point of the trial was to demonstrate Angiotensin II efficacy in a patient that was failing high dose norepinephrine alone (or equivalent dose of another vasopressor). So the trial was not really Angiotensin II against just placebo as both groups were also on high dose catecholamine.

https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0534-9

https://www.nejm.org/doi/full/10.1056/NEJMoa1704154

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764562/

https://www.ncbi.nlm.nih.gov/books/NBK470431/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691094/

https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/Treatment-of-right-heart-failure-is-there-a-solution-to-the-problem

In this episode, 2 Intensivists Dr. Srinivasan and Dr. Patel visit Resus Now to discuss todays approach on taking care of patients with COVID 19 illness.  Please see below articles for evidence related to todays topic.

Dexamethasone article:
https://www.nejm.org/doi/full/10.1056/NEJMoa2021436

Tocilizumab article:
https://www.nejm.org/doi/full/10.1056/NEJMoa2028836

Vitamin C article:
https://link.springer.com/article/10.1007/s43440-020-00176-1

Reading about zinc:
https://www.covid19treatmentguidelines.nih.gov/adjunctive-therapy/zinc/

Reading about melatonin:
https://consultqd.clevelandclinic.org/melatonin-a-promising-candidate-for-prevention-and-treatment-of-covid-19/

Remdesivir article:
https://www.nejm.org/doi/full/10.1056/NEJMoa2007764

Pepcid reading:
https://hartfordhealthcare.org/about-us/news-press/news-detail?articleid=28305&publicId=395

Anticoagulation in COVID:
https://www.universityhealthsystem.com/~/media/files/pdf/covid-19/guidelines-for-anticoagulation-in-hospitalized-covid-19-patients.pdf?la=en

Anticoagulation in COVID:
https://www.uptodate.com/contents/image?imageKey=HEME/128045

Heparin resistance in COVID:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7242778/

Anticoagulation in COVID:
https://www.nejm.org/doi/full/10.1056/NEJMclde2028217

In this 5 minute bit, we discuss pearls and pitfalls with Norepinephrine, epinephrine, dopamine and vasopressin. Please see below for evidence related to our topic.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495871/

https://pubmed.ncbi.nlm.nih.gov/18654759/

https://emcrit.org/pulmcrit/renal-microvascular-hemodynamics-in-sepsis-a-new-paradigm/

https://www.nejm.org/doi/full/10.1056/nejmoa0907118

Review the below articles thoroughly before placing a temporary dialysis catheter.  Remember RIJ is site of choice followed by femoral.  LIJ not ideal and avoid subclavian.  Enjoy and thank you for all of your support for Resus Now!

https://www.ncbi.nlm.nih.gov/books/NBK539856/

http://maryland.ccproject.com/2014/03/11/vascular-access-renal-replacement-therapy/