RAGE Session: “What’s the Sats Target?”

It is time to RAGE again! This Session is 61:38 min long and includes:

• Introduction… kind of (starts 00:00 min)
• ‘What’s bubbling up?’ (starts 04:48 min) — an ED checklist for cognitive debiasing, are ‘cold’ platelets ready for primetime, the ART trial and the open lung approach to ventilation using recruitment manoeuvres
• ‘What’s The Sats Target?’ (starts 22:55 min) — the RAGE team discuss what SpO2 targets to aim for, in which patients and diseases, and the tricks and traps of real-world clinical practice.
• ‘A blast from the past’ by Chris Nickson on ‘Rudolf Virchow’ (starts 52:52 min)
• ‘Words of Wisdom’ from Cliff Reid (starts 57:10 min)

Show notes for this RAGE Session:

What’s bubbling up?

• Graber ML, Sorensen AV, Biswas J et al. Developing checklists to prevent diagnostic error in Emergency Room settings . 2014; 1(3)
• Mike Clancy’s Cognitive Checklist
• Diagnosis: Interpreting the Shadows by Pat Croskerry et al (Google Books)
• All Doctors Are Jackasses by Chris Nickson (LITFL)
• Johnson L, Tan S, Wood B, Davis A, Marks DC. Refrigeration and cryopreservation of platelets differentially affect platelet metabolism and function: a comparison with conventional platelet storage conditions. Transfusion. 2016; 56(7):1807-1818. [pubmed]
• FDA Approves Cold Platelets For Resuscitation
• ART investigators writing group. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2017; 318(14):1335-1345. [pubmed] [article]
• Open Lung Approach To Ventilation (LITFL CCC)
• Lung Recruitment Manoeuvres (LITFL CCC)

What’s The Sats Target?

• Oxygen Saturation Targets in Critical Care (LITFL CCC)
• Oxygen: The Molecule that Made the World by Nick Lane
• Grocott MP, Martin DS, Levett DZ, et al. Arterial blood gases and oxygen content in climbers on Mount Everest. The New England journal of medicine. 2009; 360(2):140-9. [pubmed]
• Unger S, Cunningham S. Effect of oxygen supplementation on length of stay for infants hospitalized with acute viral bronchiolitis. Pediatrics. 2008; 121(3):470-5. [pubmed]
• Schroeder AR, Marmor AK, Pantell RH, Newman TB. Impact of pulse oximetry and oxygen therapy on length of stay in bronchiolitis hospitalizations. Archives of pediatrics & adolescent medicine. 2004; 158(6):527-30. [pubmed]
• BTS Guidelines for Oxygen use in Adults in Healthcare and Emergency Settings and the prehospital appendix
• TSANZ Acute Oxygen Guidelines
• Oxygen and CO2 Retention in COPD (LITFL CCC)

Blast from the Past

• Rudolph Virchow (Wikipedia)
• Refugees (Amnesty International)
• UN Slams Australia’s Human Rights Record (The Conversation)

Words of Wisdom

We have room to act, to shape our stories, though as time goes on it is within narrower and narrower confines. A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.”

Atul Gawande, Being Mortal:: Illness, Medicine and What Matters in the End