DrVenu's Broadcasts

Dear Faculty 

Kerala sociocultural scenario is totally different from other parts of the state .  A huge number of our population are working abroad or away from core family . Parents are alone in many families . Renal disease , Cancer ,Complicated diabetes , COPD , Stroke , CAD etc are so rampant in our state . Old age and related issues are common . Emergency departments has got its own impact due to this health profile. Emergency doctor has likely to phase a lot of decision issues and forced to a huge emotional interface while managing patients with end stage diseases . Each one of you should learn how to de-escalate aggressive EM approaches and higher end resuscitation mode to comfort care . You must receive special training in this field . As you know we can not document DNR in case sheets . What we can document only as "palliative care only " . But this decision should come from primary physician and he should take this decision after discussing with blood relatives of the patients in a joint meeting with all concerned . In such cases no need to call Code blue . If at all you come across such a code blue , you must communicate with primary physician and de-escalate your resuscitation process which confine to BLS level and no need to rush lab and imaging studies .  Obviously you must escalate into effective communication mode . You must follow  7 C s of of comfort care  here "Confirm, Communicate ,Consent,Consolidate ,Consider,  Confine , Concerns and Conclude " 

Dr Venu 1.12.16

DrVenu'sBroadcasts

LEMON approach in one of the most commonly used tools to evaluate airway difficulty in ER . Very often we are all so fascinated about Mallampatti which is the 3rd letter in the Lemon . Interestingly it has got limited or no role in real emergency like unresponsive patients . Practically LEON is more appropriate in ER . But in trauma cases N "Neck Mobility" assessment going to be  disastrous and contraindicated . So LEO will be enough in such situation . Don't forget alteast to do LEO in all cases before airway management and document if any .. Essentially each and every one should fill the airway check list including assessment sheet before airway interventions DrVenu 29.12.16

DrVenu's Broadcasts

RSI is a process to be executed with extreme caution and precaution. It can be the potential minefield for many airway disasters. The agents used in RSI is highly potent and potential for dangerous complications. RSI in ER may likely to cause errors in execution. The in depth knowledge of drugs using RSI is absolutely essential. The drugs must be handled by doctors only and faculty supervision is mandatory. Once a drug administrator through IV route means it is similar to throwing a stone. No way to get back. So what is needed is double caution . Follow safe practice. Follow syringe protocol while performing RSI. Load depolarising agents like Scoline in 2cc syringe, non Depolarizing Angents like Vecuronium in 5cc syringes and Induction agents like Etomidate , Propofol etc in 10cc syringes. Lebel it appropriate way and check three times before its administration. If you are not following it ,kindly follow this now onwards 

DrVenu/28.11.201

DrVenu's Broadcasts

Gum elastic bougie can use if there is some visibility of glottis at least tip of epiglottis. An external laryngeal manipulation can covert a gr 4 larynx to 3  or more . This will facilitate bougie usage . You cannot use bougie in a totally non visible larynx . DrVenu

Dr Venu's Broadcasts

Dear colleague,

Airway errors are so common , rampant, especially tube displacement. Every transport is prone for such airway disasters. Recently we had a displaced tube issue in the group which was accompanied by a faculty. Displacement was identified by Icu people . We were not able to identify the displaced tube. This phenomenon is universal. That is why NAP 4 study emphasis the use of capnography in all intubations and all transports should be under capnographic monitoring only. I ask you to keep this standard in all of your airway interventions and transports irrespective of intra or inter hospital transports. If your department is not equipped to this level , urgently raise a CAPX and implement it.  Personally you must look into it and the needful to make it happen. DrVenu 

25.11.16