Learning how to have an emergent, effective, and compassionate family meeting on goals of care is as important a skill as intubation or chest drain. Needs as much training and practice. Need to know their wishes and expectations to guide them forward.

Pulmcrit has a bit on this topic but of course every patient encounter has unique challenges
emcrit.org/ibcc/storm/#...

Interesting. I think in these cases the jury is out but the question about the role of epi is valid. Some would say Esmolol or maybe lidocaine? While trying to teleport to cath lab? Tough patient

Frostbite or snake bite? My mistake 😂

Super interesting topic. Were you successful in your defib, but they would quickly devolve back to VT/VF? Or did the VT/VF persist despite shocks? How was the ECG before arrest, any STEMI/OMI?

That's interesting! Honestly I'm 100% sure they aren't recommending EMS to insert a-lines routinely in shock, but I think we can use this info to improve decision making in the ED and in-hospital critical care setting.

I read such research more as a story rather than like a guideline. Many UK HEMS services routinely provide pre-hosp crit care interventions and so they have a fairly unique viewpoint to research critical illness! We might then try and extrapolate the physiology to our own patients wherever they are.

Just realised that the authors touch on this idea at the end of their Discussion. I think overall I would say that NIBP isn't best at detecting radio-femoral discrepancy ... But rather if we have escalating vasopressor requirements + cool (?mottled) fingers it's worth going femoral!

I suppose in that situation brachial (NIBP) may be better as it's more central? I wonder if the difference relates to the patients and underlying pathologies, pre-hospital and undifferentiated pathologies vs in the ICU and on pressors? @icmtim.bsky.social will probably know.(2/2)

Thanks for sharing this interesting article. I don't think they contradict each other, I think they each explore useful questions! I've seen other data (plus personal anecdotes) of radial art line pressure greatly underestimating the true pressure when on high doses of pressors. (1/2)

This would also give you time to pre-ox, get some monitoring on and vitals, before paralysis. Safer for patient and for nurses/team members restraining and trying to get a line in.