About Charles Bruen

Cardiac Intensivist, Resuscitationist, Emergentologist. Educator. Doodler. Friend. Most importantly, husband to my wife & superhero to my son.

ECMO Ultrasonic Flow and Bubble Sensor

2016-10-13T18:16:21-05:00April 21st, 2015|ECMO|

Understand the workings and tips for best use of ECMO ultrasonic sensors. ECMO centrifugal flow pumps require external sensors to provide accurate measurement of blood flow rates based on differential acoustic transit time due to the Doppler effect. The acoustic mirror of bubbles allow for easy detection of air in the line also.

Prone Positioning Tips and Checklist

2016-10-13T18:16:21-05:00April 15th, 2015|Pulmonary, Safety, Stabilization|

Prone positioning in ARDS can improve lung compliance and ventilation-perfusion matching which improve oxygenation and may have a mortality benefit. It requires significant effort and staff coordination to perform safely and efficiently. In this article we include tips for preparation, and a detailed checklist for performing proning efficiently and safety.

ECMO Flow Sensor Coupling Paste

2016-10-13T18:16:21-05:00April 10th, 2015|ECMO|

With centrifugal flow pumps, the ECMO circuit blood flow rate is dependent not only on the pump rotational speed, but also upstream and downstream pressures. Ultrasonic flow transducers provide are able to provide accurate measurements. The ECMO ultrasound flow sensors require a conductive interface between the sensor and the circuit.

Dantrolene for Malignant Hyperthermia

2016-10-13T18:16:21-05:00April 6th, 2015|Pharmacology, Safety, Toxicology|

Malignant hyperthermia is a life-threatening reaction to volatile anesthetics and the neuromuscular blocking agent succinylcholine, which results in high body temperatures. Dantrolene counters the reaction by blocking the release of calcium from the sarcoplasmic reticulum, and reducing the intracellular calcium.

Post-Catheterization Hemoglobin Drop

2016-10-13T18:16:21-05:00April 1st, 2015|Cardiology|

Hemorrhage is a feared and potentially life-threatening complication following catheterization. This may reflect retroperitoneal hemorrhage, pericardial bleeding including cardiac tamponade, gastrointestinal, intracranial, or hemolysis. However, there can also be benign or procedural causes.

vv-ECMO Gas Exchange

2016-10-13T18:16:23-05:00February 14th, 2015|ECMO|

Gas exchange in vv-ECMO is effected by four critical factors. There needs to be adequate effective ECMO blood flow compared to cardiac output and minimal recirculation. Oxygenation can then be set with the blender and carbon dioxide removal is determined by the sweep gas flow rate.

Perc Trach difficulty caused by deformed Shiley edge

2016-10-13T18:16:23-05:00February 14th, 2015|Airway|

During a percutaneous tracheostomy procedure, the edge of the Shiley tracheostomy tube can catch on the tracheal rings deforming the shape and making it difficult to cannulate into the trachea. This can occur even if the bevels of the Shiley and trocar are aligned perfectly.

Fiberoptic Awake Oral Intubation

2016-10-13T18:16:24-05:00February 13th, 2015|Airway|

Fiberoptic oral intubation with flexible fiberoptic scope is useful technique for intubating a patient in respiratory distress which it is desirable to maintain spontaneously breathing during the intubation. Tutorial and procedure steps for performing fiberoptic awake oral intubation including equipment, preparation, and medications.

Perc Trach Step-by-Step Tutorial

2016-10-13T18:16:24-05:00February 12th, 2015|Airway, Procedures|

For patients that require prolonged mechanical ventilation, a tracheostomy can be placed either in the operating room as an open surgery, or more preferably at the bedside with a minimally invasive procedure in the intensive care unit by a percutaneous dilational technique under bronchoscopic guidance. This is a step-by-step tutorial for patient selection and procedure techniques.

Perc Trach Procedure Documentation

2016-10-13T18:16:24-05:00February 12th, 2015|Procedures|

Part of performing a bedside percutaneous tracheostomy is the procedural documentation. Given that this is a surgical procedure, the documentation should be more thorough than you may be accustomed to doing for an arterial line or central line. Here is a sample procedure note that can be adapted to your local practice.