VENTING YOUR FRUSTRATIONS – Dr Stacy Turner

take away points:

low pressure, low volume

optimise expiratory time if obstructive pathology

titrate FiO2 (88-95%), then adjust PEEP to FiO2

trouble shooting:

check compliance/resistance

MV depends on the patient – if awake patient has higher RR (eg: DKA, sepsis), need to raise RR to normalise pCO2 to awake patient compensation

set alarms to AUTO, check peak pressure set to “40”

“Deterioating patient” algorithm

TAKOTSUBO TRICKS – Dr Ross McNaught

Stress induced cardiomyopathy with normal coronary arteries – emotional stress, sepsis, respiratory failure

Usually completely recovers in weeks to months, may recur

Pathophysiology – catecholamine excess

Atypical features – no chest pain

ECG shows ST elevation, anterior leads

Echo – most common is left ventricular “ballooning” and apical hypokinesis

Consider concurrent LVOT: AVOID inotropes

b-blockers

fluid resuscitation

Medical duty of care – restraints required to complete medical responsibilities safely

RED form

Mental Health Act forms – must notify on-call psychiatrist

Document forms + in patient notes, maximal time for medical review is 4 hours – review of restraints must also be documented on forms and in notes

“Consent” – must inform patient or next-of-kin of use of restraints, document “consent” or why obtaining consent was inappropriate