PEM Playbook – Adventures in RSI

Pediatric airway management is a skill that integrates the three types of knowledge as described by the ancient Greeks:
Episteme — theoretical knowledge
Techne — technical knowledge
Phronesis — practical wisdom — also called prudence.

Here we’ll invoke each type of knowledge and understanding as we go beyond the anatomical issues in pediatric airway management – to the advanced decision-making aspect of RSI and the what-to-do-when the rubber-hits-the road.

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Blood cultures: when do they make a meaningful impact on clinical care?

Bacteremia affects 200,000 patients per year, with the potential of causing significant mortality. Blood cultures are considered the most sensitive method for detecting bacteremia and are commonly obtained in patients with fever, chills, leukocytosis, focal infections, sepsis, or suspected endocarditis. However, what is the literature behind obtaining cultures in the ED?

Taking Ownership of the Ventilator – How to Manage and Troubleshoot

Your overnight junior calls for your help with his decompensating intubated patient. The patient is a 54 year-old male with a history of COPD who was intubated ten minutes ago. The ventilator is alarming due to high pressures. The patient’s current vitals are HR 140, BP 80/50, SpO2 82%. The ventilator settings are VCV rate 12, tidal volume 450, PEEP 15, FiO2 100%. You quickly disconnect the circuit but the patient is not improving. What do you do next?

Emergency Medicine Education