Start Peripheral Vasopressors Early in Shock!
It has been dogmatically believed that prolonged infusion of any vasopressor mandates placement of a central line. However, available evidence doesn’t support this. Diluted solutions of all catecholamines are safe (except Vasopressin) to be administered peripherally via a well functioning 18-20G IV or larger in forearm (no hand/wrist/AC) . No old IVs (>72 hrs) Know how […]
Know Your IV Fluids
Normal (Abnormal) Saline vs. Ringer’s Lactate
The choice of crystalloid fluid for volume resuscitation is debated often. With rising concern about the effect of hyperchloremic metabolic acidosis associated with normal saline, clinicians more commonly are opting for balanced crystalloids, such as lactated Ringer’s solution or Plasma-Lyte.
What’s the “Best” Site for Central Line Placement?
Using the subclavian site for central venous catheterization reduced infections and DVT to a minimum, but tripled the risk of pneumothorax compared to the internal jugular (IJ) position. Using the femoral position eliminated pneumothorax risk, and was comparable to the IJ in infection risk, but significantly increased DVT risk.
Size does matter
If you want to get big water into your patient, observe the following recommendations: Gauge is king. Choose the fattest tube you can stick into the patient. When it comes to catheter length, it’s not the size… it’s how you use it. Shorter catheter lengths mean less resistance. Consider plugging your drip set directly into […]
Spreading the Word: Ringer’s Lactate is Safe in Hyperkalemia
Infusing Ringer’s lactate (RL) in a patient with hyperkalemia will actually lower his serum potassium level.
I’m just drunk NOT vitamin deficient so stop with the ‘bananas’
Most of our intoxicated patients are not vitamin deficient and don’t need supplementation. The real kicker is that we almost never really try to find out if the patient might be a chronic abuser and potentially at risk. We just hang the bag. Remember, everything we do in medicine has a potential downside. And if […]
Do you know which IV cannula can deliver fluid to your patient the fastest?
For decades now we’ve all been reciting the mantra that any sick or shocked patient needs: “2 large bore IVs” but do you know which IV cannula can deliver fluid to your patient the fastest?
Air bubbles in your patients IV line?
Air embolism from IV tubing: In most cases, it will require at least 50 mL of air to result in significant risk to life, however, there are case studies in which 20 mLs or less of air rapidly infused into the patients circulation has resulted in a fatal air embolism.
