Kaleb Lachenicht retweeted
Peri-op cardiac arrest - how can we do better?
• team briefings
• in situ multidisciplinary simulation
• teaching generic cardiac arrest team competencies
• mandatory training for rare anaesthetic events
@jpenketh39 @JerryPNolan
buff.ly/3Zgrypy
Kaleb Lachenicht retweeted
The Sepsis Guidelines emphasize on early administering broad-spectrum antibiotics, appropriate fluid resuscitation, measuring lactate, and initiating vasopressors if clinically indicated within the first hour of sepsis recognition.
See more teaching at:
youtube.com/@jackcfchong
Kaleb Lachenicht retweeted
Our latest case report - another instance of bougie familiarity and skills leading to safer airway management. @kmconnel78 @BritFltdoc @mack99301 @Trev074Trevor @UWMedFlight @UWEmerMed @MadtownEM @cliffreid @AMPAdocs @ATACCFaculty @DipRTM @UCAirCareDoc
sciencedirect.com/science/ar…
Kaleb Lachenicht retweeted
🧵 1/8
Excited to share a win!
Our ICU is launching a positive reporting system where staff can recognise each other's excellence.
Already works brilliantly in our ED & retrieval service - now expanding thanks to amazing colleagues running with the idea!
#HealthcareExcellence #PositiveCulture
Kaleb Lachenicht retweeted
Extubation Readiness: A to L Checklist
We're obsessed with safe intubation, but what about taking the tube out?
How do we assess extubation readiness?
Here's my simple, alphabet-based A to L checklist:
1/17
Kaleb Lachenicht retweeted
Before DCing Pts From the ED…I Have a Checklist of 6 Things (Like a Procedure Checklist):
-Stable VS
-Clinical sobriety
-Ability to care for oneself
-No new complaints
-Complete eval of all triage complaints
-Review all labs/imaging one more time
#MedEd #AvoidingMalpractice
Kaleb Lachenicht retweeted
I'm reposting this again because it's so important
as a trainee, attendings with different styles can be frustrating
(you just learned one style and want to do that!)
but learning diverse approaches to a single problem will serve you well later on, by teaching flexibility
Kaleb Lachenicht retweeted
Non-invasive BP measurement in prehospital critical care is less reliable the sicker you are
Thanks @stemlyns & @EMManchester for this post on a great prehospital paper by @DrYaniPerera and colleagues from @TVAirAmb
Great paper showing that non invasive BP measurement is unreliable in a PHEM case mix. #IABP better and feasible in prehospital care #foamed stemlynsblog.org/non-invasiv…
Kaleb Lachenicht retweeted
Emergency Department Pericardiocentesis
Great video with many practical tips
youtu.be/0aoQdhfCX2A?si=3G8y…
Kaleb Lachenicht retweeted
Psychological safety is not just a ‘tick box’ exercise in simulation & just to say ‘this is a safe space’. It is a fundamental concept that needs nurtured & built on trust. It can be fragile-therefore needs to be maintained throughout the simulation #PsychologySafeContainer
Kaleb Lachenicht retweeted
He laughs. “Beer and Skittles, doc.”
He shakes my hand, we say our goodbyes, and I sit down in my office to chart.
Name. Date of birth. Diagnoses. Data. Forms. Structure.
None of it conjures the image.
A dog, a car, a way home.
Three wishes.
Ships in a harbor. Harbour.
Kaleb Lachenicht retweeted
Let’s mention some tips:
1. Very few intubations are really “crash” ones. Use the time to optimize yourself, the patient and the environment
2. Pre-oxygenate almost everybody with NIV. Use common sense and the PREOXI trial findings
3. Use waveform capnography (not colorimetric)
Each pearl ⚪️ of wisdom adds to the thread, creating a valuable chain of pearls.
Cc @KalagaraHari @ross_prager @msiuba @khaycock2 @chatterJ5 @Wilkinsonjonny @IM_Crit_ @iceman_ex
Kaleb Lachenicht retweeted
nice reminder that epinephrine is a banger for patients on the verge of dying
norepi: improve the Bp
epi: improve the Bp, improve cardiac output, treat anaphylaxis, treat status asthmaticus, treat bradycardia
look at this list of pts who survived with a dirty epinephrine gtt:
It took 15 years, but the dirty epi drip is finally evidence-based. Aussies come through again.
onlinelibrary.wiley.com/doi/…
Kaleb Lachenicht retweeted
Follow on from previous post. The plastic star foreign body was retrieved from the larynx. The granulation tissue then removed. The toddler made good recovery. What a star! #ENT #entsurgery #surgeon #airway #larynx #airwayhealth
Kaleb Lachenicht retweeted
Recording tomorrow, last chance to get some horribly complex questions in for @heli_med_james & @robfenwick …
Kaleb Lachenicht retweeted
Intubation for hypoxaemia and septic shock
Emergency medicine specialists in black scrubs
One on haemodynamics, one on oxygenation
Art line in, Peripheral norepi, epi 1:100000 ready to push
Ramped, preox via NIV-ST mode on Hamilton, allowing supported ventilation during induction
Intubated first pass over bougie using VL by emergency medicine trainee. No desaturation.
Resus nurses all over it
Calm, smooth, safe. Just like we train
No random ideas or drug combos introduced by a clinician that you've never met before
A shared mental model in a cohesive trained team leads to effective resuscitation
Kaleb Lachenicht retweeted
We just published a pediatric distal femur IO study in #PrehospitalEmergencyCareJournal.
This is the first publication demonstrating the success of this site in the pediatric population.
A huge thanks to my team at @PBCFR for promoting and encouraging high quality EMS research. 🙏
Kaleb Lachenicht retweeted
#Fluids 💧& #Sepsis: Less is More?
1️⃣💧hemodynamic effects are fleeting
2️⃣ Coin-toss probability in 💧responsiveness assessment;
3️⃣💧responders rapidly become non-responders
4️⃣💧responsiveness tools: limited applicability in #ICU #PedsICU
5️⃣💧=drugs w/serious adverse effects
Kaleb Lachenicht retweeted
🚨 2024 Corticosteroid Guidelines Update! 🌐
Sepsis:
1️⃣ Suggest corticosteroids in septic shock (low certainty) 💉
2️⃣ Strongly against high-dose, short-term use (>400 mg/day) 💉
ARDS:
3️⃣ Suggest corticosteroids for critically ill adults 💡 (moderate certainty)
Severe CAP:
4️⃣ Recommend corticosteroids in severe cases 💡
🚫 No recommendations for pediatric use in sepsis, ARDS, or CAP.
🔮 Future research is needed in pediatrics & long-term impacts
journals.lww.com/ccmjournal/…
🧪 #CriticalCare #Sepsis #ARDS #CAP #Corticosteroids #MedicalUpdates
