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Posted by mdaware on November 01, 2023

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Selling Ice Cream in the Desert

It's clear from both evidence and experience that NIV (aka NIPPV, CPAP, BiPAP) is very helpful for most acutely sick, dyspneic patients on a range of outcomes: symptom improvement, oxygenation, potential avoidable intubation, or preoxygenation for ETI. However, many patients are initially resistant to NIV for a variety of reasons including: hypoxic delirium delirium from the disease process itself hypercarbia sensation of drowning, i.e. the worst sensation in the world While some may question why patients don't always instantly welcome lifesaving therapy with open armed-compliance, it's easy to understand why someone you've never met strapping a mask to your head that blows air into your face from a big noisy machine while other people prod you with needles and place stickers and cuffs on you while monitors and vents alarm left and right on may not seem like the most comfortable situation in the world. Over the past few years, I've developed my own h

Bimanual Laryngoscopy

This is adapted from a comment I left in response to an excellent Broome Docs post on RSI updates BURP vs burp I am a much bigger fan of external laryngeal manipulation (ELM) above BURP. Put simply: Sellick: pressure on cricoid BURP: assistant puts backwards-upward-rightward pressure on thyroid cartilage ELM: laryngoscopist moves around the thyroid cartilage with their right hand, in any direction As mentioned in the Broome Docs post , the goal of Sellick is to prevent gastric insufflation and passive regurgitation, while BURP and ELM are laryngoscopy aides; as also discussed at Broome Docs , Sellick is likely: useless for it's intended goal; often worsens your glottic view; and, may impair tube delivery. Therefore, I've taken it off my radar as there's enough more important things for us all to think about during airway management. I think of BURP as a "good guess" at the optimal movement (I would guess about 60% accurate). The technique I lea

Urine Drug Screen False Positives

Update: a version of this is now in PubMed Central -- thanks Pik Mukherji! Mukherji P, Sharma S. Toxicology Screening. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499901/ Urine drug screens aren't completely useless, but they have a number of limitations . Here is a table where I have compiled all of the false positive causing drugs I could find ( pdf ): Update 4/22/2016: Here are my sources: I started with this paper which was I originally heard on EM Abstracts (Jan 2011): Brahm NC, Yeager LL, Fox MD, Farmer KC, Palmer TA. Commonly prescribed medications and potential false-positive urine drug screens. Am J Health Syst Pharm . 2010 Aug 15;67(16):1344-50. Special thanks to Jon Cole from Hennepin who made this fantastic video . Other sources include: UMHS Guidelines for Clinical Care May 2009 Standridge JB, Adams SM, Zotos AP. Urine drug screen

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