Tuesday, October 4, 2016

Ph Kills

Resuscitation Sequence Intubation - pH Kills
"This blog post is the third part of a series of 3, on a recent lecture I was asked to give on Critical Care Updates: Resuscitation Sequence Intubation. This talk was mostly derived from a podcast by Scott Weingart (Twitter: @EMCrit) where he talked about the physiologic killers during preintubation and perintubation. In this podcast, Scott mentions the HOp killers: Hypotension, Hypoxemia, and Metabolic Acidosis (pH) as the physiologic causes of pre-intubation/peri-intubation morbidity and mortality. Taking care of these critically ill patients that require intubation can be a high stress situation, with little room for error. In part three of this series we will discuss some useful strategies at the bedside to help us not worsen pre-intubation/peri-intubation metabolic acidosis.
Clinical Bottom Line:
  • Severe Metabolic Acidosis in patients requiring intubation, if done incorrectly can lead to severe cardiac dysrhythmias
  • The possibilities to ensure this doesn’t happen include:
    • Intervention 1: Bicarbonate Therapy – This is a very controversial topic, but no controlled studies to date have shown hemodynamic improvements or improved catecholamine responsiveness
    • Intervention 2: Ventilator-Assisted Pre-OXygenation (VAPOX) – This should only be performed if there is someone who can use a ventilator and change settings