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Trick of Trade: Inflating the Esophageal Balloon of a Blakemore/Minnesota Tube without a Manometer 

ALiEM

The SB tube was created in 1950 in order to help tamponade variceal bleeds [1]. Apply traction to the tube by tying a roller bandage to the end of it and then the other end to a 1 L bag of IV fluids. Pearl 1: Check the units of pressure being used. The conversion rate is: 1 cmH2O = 0.74 1950 May;131(5):781-9.

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Congestive Heart Failure and Sepsis: A Closer Look at Fluid Management

REBEL EM

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis [published online ahead of print, 2023 Aug 9]. References: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM.

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ToxCard: Local Anesthetic Systemic Toxicity

EMDocs

1-5] Since then, many more medications have been developed and deployed. 1-5] This post focuses on the identification and management of Local Anesthetic Systemic Toxicity (LAST). 3-5,7] Symptom onset is usually within 1 minute of intravascular injection but can be delayed if multiple injections or continuous infusion. [5]

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TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding

REBEL EM

It provides highly descriptive, real-time information on clot formation, clot strength, platelet function, and fibrinolysis, which is superior to traditional coagulation tests such as INR, aPTT, and platelet count. 2020;71(1):235-246. TEG analyzes the interaction between platelets and the coagulation cascade. Article: Kumar M et al.

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Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. If this EKG were handed to you to screen from triage without any clinical information, what would you think? The patient was upgraded to the ICU for closer monitoring. What do you think? In fact, Kosuge et al. Stein et al.

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The ‘Hidden C’

Don't Forget the Bubbles

The team sits down for a hot debrief once the patient is stabilised and transferred to the ICU. Exposure impairs information sharing and overall team collaboration. Here are ten things to think about: 1. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J. 2014 Jun 26;23(12):653-9.

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Shifting the Paradigm: Can We Manage Mechanically Ventilated Patients with Occult Traumatic Pneumothorax Conservatively?

REBEL EM

Paper: Smith JA, Secombe P, Aromataris E. Only 1 RCT and 1 cohort study had only mechanically ventilated patients. The pendulum is swinging towards conservative management for occult pneumothoraces. However, minimal evidence supports conservative management of occult, traumatic pneumothoraces in ventilated patients.

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