Aug 21 2019: NIV, nitrous, bradycardia, hypothermia, neck dissection, AF

Ventilator troubleshooting and Nitrous sedation
– I have attached the charts and procedures the nurse educators were using and they are also posted here:
Bradycardia and hypothermia (Adi)
1) consider the big 4 causes of resistant bradycardia
toxins, ischaemia, potassium, hypothermia
2) have a step-wise approach to bradycardia
– treat reversible causes
trial of atropine
– chemical pacing: isoprenaline or adrenaline
– electrical pacing
3) hypothermia
– there are passive and active rewarming techniques
modifications to usual resuscitation include:
gentle handling if T < 32 (risk of VF is present but necessary procedures are necessary)
adrenaline where T < 30 probably not useful
– in arrest where T = 30-35 deg double the time interval between doses of adrenaline (ie every 8 min)
Carotid and vertebral artery dissections (Keira)
– these types of dissections are rare, but potentially devastating
– remember to be thorough and specific with your neuro exam and try to “spot the difference” with every new case to every previous case of muscular neck pain you see
– when patients represent – think about changing something – “where else” do we need to go with this case?
Journal club – delayed v early cardioversion in AF (Yasmin)
– another study suggesting that rhythm control is not as important as rate control