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ERcast Lite

Welcome to ERCast, a focused discussion on the questions, quagmires and known unknowns we face everyday in the emergency department.

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Mar 18, 2012

In this episode we talk with Dr. Scott Weingart about new developments in caring for patients in cardiac arrest including:

  • End tidal CO2 monitoring
  • Therapeutic hypothermia
  • Should all post arrest patients with return of spontaneous circulation go to the cath lab?
  • A logical approach to managing the airway during cardiac arrest resuscitation

Airway control in a cardiac arrest

What’s one of the first things that happens when a patient gets transferred from the paramedic stretcher to the ED bed? The extraglottic airway comes out and the patient gets intubated. Considering the circumstances, is doing this action within the first few minutes of a resuscitation the best use of your time, and more importantly, the patient’s time? We have a tendency to think of non-endotracheal tube airway devices as inferior and often that is the case. But is it the case here? What advantage do you get from changing out a functioning supraglottic/extraglottic airway device in the early stages of cardiac arrest resuscitation? Probably not much.

What do we always fret about when rushed placing an ET tube? Esophageal intubation. If that happens, things just went from under control to FUBAR in a hurry. At a time when you want to focus in getting good uninterrupted chest compressions, giving electricity, and sorting out what’s going on, getting definitive tracheal airway control has a low return on investment. If the patient is just being bagged with a BVM (bag valve mask), go ahead and put in a device that doesn’t require an all stop - such as an extraglottic airway device. That DOES have a return on investment because it gives you an extra set of hands now that the person who had to hold the BVM on the face is now free. Perhaps more importantly - getting a good, consistent BVM facial seal in a code is challenging. It seems easy in practice, but in the heat of battle it is not. it’s hard.

Important links:

  • The ERcast Emergency Orthopedic Conference is  being held on April 21,2011, click HERE for the brochure PDF file
  • More on therapeutic hypothermia: August 2010, ERcast
  • Interested in learning more about current decisions from the US Supreme Court? Check out Rich Orman's new podcast US Supreme Court Review
  • A good primer on "Post Cardiac Arrest Syndrome" can be found HERE