Anand Swaminathan

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SALAD Technique #emergencymedicine #criticalcare #intubation

Anand Swaminathan

@emswami.bsky.social

Suction Assisted Laryngoscopy for Airway Decontamination (SALAD) solves the challenge of the soiled airway by maintaining continuous suctioning during airway securing attempts.
1) Overhand grip of suction
2) Lead w/ suction catheter
3) Park suction in esophagus

youtube.com/shorts/vpvmy...
#EMIMCC

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Blunt Cardiac Injury #emergencymedicine #criticalcare #trauma

Anand Swaminathan

@emswami.bsky.social

Blunt Cardiac Injury
Suspect: blunt traumatic hemothorax, pulmonary contusions, esophageal/aortic injury
Not assoc w/ isolated sternal fracture
w/u: Tn and ECG - If either abnormal, admit to tele and get a comprehensive echo looking for wall motion abnormality

youtube.com/shorts/UTHbm...
#EMIMCC

1 3

Reduced Dose Insulin in HyperK #emergencymedicine #criticalcare

Anand Swaminathan

@emswami.bsky.social

IV insulin is a backbone tx in hyperK
Standard: 10 units IVP w/ dextrose
2021 meta(PMID: 33993515) looked at 10 units vs < 10 units
No difference in reduction in serum K.
Reduced risk of hypoglycemic + severe hypoglycemic events w/ reduced insulin dose

youtube.com/shorts/Sz9Zy...
#EMIMCC

3 8

Cric Practice #emergencymedicine #criticalcare #intubation #airway

Anand Swaminathan

@emswami.bsky.social

Finger-Scalpel-Bougie Approach to Cric
-If you're doing emergency airway management, you MUST be comfortable doing a cric
-Key w/ cric: have a simple approach + practice
-Don’t waste time w/ needle based approaches - they are more likely to fail

youtube.com/shorts/8fDsT...
#EMIMCC

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Anand Swaminathan

@emswami.bsky.social

Thank you!

Pericarditis and ECG Changes #emergencymedicine #criticalcare #cardiology

Anand Swaminathan

@emswami.bsky.social

Diagnosing Pericarditis:
-Pericardium is electrocardiographically silent
-Pericarditis w/ ECG changes = pericarditis w/ epicarditis or pericarditis w/ myocarditis.
-If troponin markedly elevated, trending up or patient looks toxic, admit to workup myocarditis

youtube.com/shorts/jI6Zp...
#EMIMCC

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Replace Blood With Blood #emergencymedicine #criticalcare #trauma

Anand Swaminathan

@emswami.bsky.social

Replace blood w/ blood
-No role for crystalloid in resus of a shocky trauma patient - dlutes hgb + clotting factors
-What if no blood?
1) Transport
2) Stop bleeding: tourniquet, direct pressure, pelvic binder
3) Tolerate lower BP + consider vasopressors

youtube.com/shorts/u0J9i...
#EMIMCC

4

Anand Swaminathan

@emswami.bsky.social

Ooh this is a call back. 25% of total volume?
Physiologic explanation can only get you so far, though. In ED we often see patients languishing days at home w/ elevated RR and insensible losses
Fluid load helps mitigate HD compromise w/ RSI and mech vent

Anand Swaminathan

@emswami.bsky.social

Interested in why? Why wouldn't you fluid load these patients?

1

Volume Load in Sick Asthma #emergencymedicine #criticalcare

Anand Swaminathan

@emswami.bsky.social

Don’t forget to fluid load in sick asthma
-Huge insensible losses from incr RR + WOB
-If need intubation, pos pressure vent results in incr intrathoracic pressure dropping pulmonary venous return ➡️HD collapse
-Load early w/ 20-30 cc/kg of crystalloid to avoid

youtube.com/shorts/mbOzE...
#EMIMCC

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Calcium in HyperK #emergencymedicine #criticalcare

Anand Swaminathan

@emswami.bsky.social

Ca2+ doesn’t stabilize cardiac myocytes in hyperK
-Lab data: Ca2+ restores Ca2+ dependent propagation
-Doesn’t matter clinically as Ca2+ will reverse hyperK induced ECG changes
-Ca2+ still treatment of choice in hyperK w/ significant ECG changes like QRS widening

youtube.com/shorts/Ofr-D...
#EMIMCC

Reposted by: Anand Swaminathan

Anton Helman

@emcases.bsky.social

@emswami.bsky.social guides us through some practical tips and limitations for IO placement in the crashing patient on this month's EM Quick Hits Video
emergencymedicinecases.com/video/em-qui...

Andexanet Alfa + Thrombembolism #emergencymedicine #criticalcare

by Anand Swaminathan — Reposted by: Anand Swaminathan

Anand Swaminathan

@emswami.bsky.social

Time to Ditch Andexanet Alfa?
-ANNEXA-1: No mortality benefit, incr VTE
-Real world data: Rech 2025 (PMID:40700941) no improved outcomes, 9% incr VTE w/ andexanet alfa (NNH = 11)

Mounting evidence that andexanet offers no benefit while increasing complications

youtube.com/shorts/7DGcv...
#EMIMCC

5 9

Anand Swaminathan

@emswami.bsky.social

I've been using much larger doses
Haloperidol 5 mg IV
Droperidol 2.5-5 mg IV

Have had great success w/ haloperidol for CHD, refractory migraine, refractory nausea/vomiting, gastroparesis

Simplified Approach to Vents #emergencymedicine #criticalcare

Anand Swaminathan

@emswami.bsky.social

Simplifying the Vent
-5 parameters: Mode, RR, TV, PEEP + FiO2
-Default approach: Lung Protective Strategy
-Assist Control (AC) appropriate for most
-RR 12-14, TV 6-8 cc/kg IBW. Incr RR to incr ventilation
5) Titrate PEEP + FiO2 together to achieve O2 sat over 92%

youtube.com/shorts/sLdOz...
#EMIMCC

1 3

Epinephrine in Asthma #emergencymedicine #criticalcare

Anand Swaminathan

@emswami.bsky.social

Epinephrine in asthma
-Crashing asthmatic pts may not respond to inhaled bronchodilators: severe bronchoconstriction limits med delivery
-Parenteral bronchodilators ➡️ rapid bronchodilation + can be life-saving
-Parenteral Epi dose: 0.5 mg IM or 50 mcg IV

youtube.com/shorts/MlQu5...
#EMIMCC

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Anand Swaminathan

@emswami.bsky.social

I think so. Unfortunately, I’ve got no experience with it

Reposted by: Anand Swaminathan

REBEL EM

@rebel-em.bsky.social

🫀VTach Treatment starts w/identifying underlying cause
4️⃣Here's a REBEL REVIEW describing 4 ways to manage this life-threatening arrythmia!
👀More at https://loom.ly/LNw6HwY

#FOAMed @emswami.bsky.social @mramzydo.bsky.social

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Low-Dose Vasopressin and Analogues to Treat Intraoperative Refractory Hypotension in Patients Prescribed Angiotensin-Converting Enzyme Inhibitors Undergoing General Anesthesia: A Systematic Review - P...

Anand Swaminathan

@emswami.bsky.social

There's not a ton + little that would be high quality:
ARB/ACE: pubmed.ncbi.nlm.nih.gov/28235174/

This review assessed the utility of vasopressin and vasopressin analogues for the treatment of refractory hypotension associated with angiotensin-converting enzyme (ACE) inhibitors in the perioperativ...

pubmed.ncbi.nlm.nih.gov

1

Vasopressin #emergencymedicine #criticalcare

Anand Swaminathan

@emswami.bsky.social

Early vasopressin in pts w/ liver failure + those on ACEI/ARB
1) Liver failure: vasopressin deficient. Can start early in sepsis, hepatorenal or even GI bleed
2) ACEI/ARBs theoretically reduce endogenous vasopressin stimulation
Dose: 0.03 - 0.04 U/min IV infusion

youtube.com/shorts/5W7iM...
#EMIMCC

2 2 4

Bougie Scissor Grip #emergencymedicine #criticalcare #airway #intubation

Anand Swaminathan

@emswami.bsky.social

Bougie Scissor Grip
-Hold bougie between 3rd + 4th digits (instead of pencil grip)
-4th digit is fulcrum + allows you to apply pressure w/ 3rd digit moving coude tip anteriorly
-Scissor grip gives better control of bougie allowing you to change direction of tip

youtube.com/shorts/wLsSU...
#EMIMCC

Where's the Blood? #emergencymedicine #criticalcare #trauma

Anand Swaminathan

@emswami.bsky.social

Trauma + Shock: Where's the blood?
5 Options in adults: chest, abdomen/pelvis, retroperitoneal space, long bones, street
Can get chest/abdomen w/ eFAST
Can get long bone from physical + street from history
RP space is a black box - need CT to get that info

youtube.com/shorts/kRWsd...
#EMIMCC

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Left Sided Thoracotomy + the Right Chest #emergencymedicine #criticalcare #trauma

Anand Swaminathan

@emswami.bsky.social

ED Resuscitative Thoracotomy
-L sided thoracotomy gives you access to heart + aorta but not to R chest
-If you do a L sided thoracotomy, you still need to do a R sided thoracostomy
-If there’s significant blood from the R chest, extenend incision to a clamshell

youtube.com/shorts/k5Pr3...
#EMIMCC

Anand Swaminathan

@emswami.bsky.social

This is a great way to use LLMs in medicine. Simply letting the LLM do all the work will invariably lead to numerous issues but a "triple-threat" approach makes a lot of sense

@pulmcrit.bsky.social
emcrit.org/pulmcrit/tri...

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Anand Swaminathan

@emswami.bsky.social

I've not seen this

1

Reposted by: Anand Swaminathan

Eric Jaeger, JD, NRP

@ericjaeger.bsky.social

Anticipate hypotension in every RSI patient. The literature says that post-intubation hypotension is extremely common, regardless of which medications or dosages you select. In some studies 40% to 50%.

Push dose epi prepped for EVERY RSI. And if at all shocky, start low dose norepi infusion.

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Rocketamine Dosing #emergencymedicine #criticalcare #airway #intubation

Anand Swaminathan

@emswami.bsky.social

Rocketamine Dosing
-Ketamine:1.5 mg/kg
-Roc standard dose (0.6 mg/kg) w/slow onset (90-120 sec)
-Roc 1.2 mg/kg faster:45-60 sec
-Issues w/ 1.2 mg/kg: in shock, paralytic onset delayed + hard to multiply by 1.2 in high-risk scenarios
-Go w/ 1.5 mg/kg instead

youtube.com/shorts/vehIN...
#EMIMCC

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Cerebral Edema in DKA #emergencymedicine #criticalcare #pedsemergencymedicine

Anand Swaminathan

@emswami.bsky.social

Cerebral Edema in DKA
-Can result in rapid neurological deterioration
-Assoc w/ fluid volume + bicarb but no causality
-Key: prompt identification + rapid tx
-Clinical diagnosis: lethargy, new neuro signs/symptoms
-Treatment: 3% hypertonic saline 3 cc/kg

youtube.com/shorts/65vMI...
#EMIMCC

Rhythm Check vs Pulse Check #emergencymedicine #criticalcare #resuscitation #cardiacarrest

Anand Swaminathan

@emswami.bsky.social

Rhythm check + pulse check not same: rhythm check looks for electrical activity, pulse check for mechanical activity

-Rhythm= VF/VT, no need waste time on pulse. Defib + resume compressions
-Rhythm= organized cardiac activity, check for mechanical activity w/ US

youtube.com/shorts/72F17...
#EMIMCC