UMEM Educational Pearls

There have been so many great talks at ACEP 2013, but Dr. Michael Winters' talk "The ICU is NOT Ready for Your Patient" was chock full of great critical care pearls. Here are just a few:

  • Increased mortality for ICU patients boarding in the Emergency Department; the increase is 1.5% per each hour of delayed transfer.
  • Intubated patients should receive analgesia BEFORE sedation; fentanyl is recommended because hemodynamically stable, but you can use anything. Good analgesia will also reduce total sedative dosing
  • Use continuous capnography for the intubated patient; can detect equipment malfunction and allow titration of ventilation
  • Keep an eye out for abdominal compartment syndrome. Physical exam is not always conclusive, should obtain bladder pressures
  • Reduce the risk of ventilator-associated pneumonia by keeping endotracheal cuff pressures adequate and keeping the head of bed elevated 30-45 degrees


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