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Podcast 720: Blakemore & Minnesota Tubes: Part I

Emergency Medical Minute

Release Date: 10/12/2021

On the Streets #11: Salient Pre-hospital Considerations for Neurosurgical Emergencies - a Smorgasbord show art On the Streets #11: Salient Pre-hospital Considerations for Neurosurgical Emergencies - a Smorgasbord

Emergency Medical Minute

On this episode of On The Streets, host, Jordan Ourada sits down with neurosurgeon/neurooncologist Dr. Eddie Tsvankin to discuss various topics concerning neurosurgery and how EMS workers in the field can better understand and manage neurological emergencies. In this episode specifically, you’ll hear Jordan and Dr. Tsvankin discuss topics including: Priorities in caring for patients experiencing seizures Short and long-term complications of tumor resection surgery Specifics on how brain tumors are operated on and the difficult decisions that must be made ahead of time Assessment of...

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Podcast 720: Blakemore & Minnesota Tubes: Part I show art Podcast 720: Blakemore & Minnesota Tubes: Part I

Emergency Medical Minute

Contributor: Dylan Luyten, MD Educational Pearls: Minnesota Tube has an extra port for suctioning otherwise is the same as a Blakemore Tube Indicated in MASSIVE upper GI bleeding often due to esophageal varices Esophageal varices are dilated, tortuous vessels in the esophagus due to increased portal venous pressure that can bleeding into the upper GI tract Patients with massive upper GI bleed should be intubated prior to placing a Blakemore/Minnesota tube References Meseeha M, Attia M. Esophageal Varices. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls...

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Podcast 719: Normal Saline vs. Tap Water for Wound Irrigation show art Podcast 719: Normal Saline vs. Tap Water for Wound Irrigation

Emergency Medical Minute

Contributor: Ricky Dhaliwal, MD Educational Pearls: Multiple RCTs and a Cochrane Review found there is no difference in wound infection rates when irrigating with tap water  Pressure of the water and how extensively the wound is irrigated were the most important factors affecting infection rates Quantity and type of water were independently not as important References Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database Syst Rev. 2012;(2):CD003861. Published 2012 Feb 15. doi:10.1002/14651858.CD003861.pub3 Lewis K, Pay JL. Wound Irrigation. [Updated 2021 Jun 4]. In:...

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Podcast 718: Renal Failure Follow Up show art Podcast 718: Renal Failure Follow Up

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Patients with acute renal failure often need medical management for hyperkalemia Those with severe electrolyte derangements or absent renal function may need emergent dialysis as well Dialysis catheters are 12 or 14 french catheters placed in the right internal jugular or left subclavian Placement is very similar to a central line or cordis catheter Trialysis catheter is one option that has an extra port that can be used for regular medication administration and drawing blood Do not default to use dialysis catheters for normal ED access due to...

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Podcast 717: A cautionary tale of renal failure show art Podcast 717: A cautionary tale of renal failure

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Hyperkalemia can cause EKG changes such as a widened QRS The fastest electrolyte results can be obtained off a VBG with electrolytes  or point-of-care labs Hyperkalemia may be reported as “hemolyzed” which indicated lysis of red blood cells and artificial elevation of the potassium level. However, always keep in mind the clinical context and look at other metabolic abnormalities like creatinine and BUN for other clues that it may actually not be hemolyzed References Co I, Gunnerson K. Emergency Department Management of Acute Kidney...

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Podcast 716: Resuscitation Fluids show art Podcast 716: Resuscitation Fluids

Emergency Medical Minute

Contributor: Nick Tsipis, MD Educational Pearls: Fluid choice may have an impact on outcomes in resuscitation, and a meta-analysis has relevant insight into their use in sepsis and trauma patients Large volume normal saline fluid resuscitation in sepsis is associated with acute kidney injury and metabolic acidosis compared to Lactated Ringers Choice of fluid did not have significant differences in trauma patients for initial resuscitation References Tseng CH, Chen TT, Wu MY, Chan MC, Shih MC, Tu YK. Resuscitation fluid types in sepsis, surgical, and trauma patients: a systematic review and...

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Podcast 715: Heated High Flow O2 show art Podcast 715: Heated High Flow O2

Emergency Medical Minute

Contributor: Nick Hatch, MD Educational Pearls: High flow nasal cannula (HFNC) or “heated high flow” can deliver higher oxygen levels than nasal cannula It typically is used as an “intermediate” between oxygen via nasal cannula and other non-invasive positive pressure devices, such as BiPAP Can modify both the FiO2 and flow rate Maximum flow rate is typically  60 liters per minute (compare that to a typical breath that is 30-40 L/min) Humidification of HFNC is important due to risk of epistaxis from drying out the nasal mucosa Large energy expenditure to humidify airflow by a...

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Podcast 714: Intradermal Sterile Water for Back Pain show art Podcast 714: Intradermal Sterile Water for Back Pain

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Randomized controlled-trial evaluated intradermal injections of sterile water to manage low back pain versus an IV NSAID Four intradermal injections of 0.1 cc sterile water in a square around the area of musculoskeletal pain Reduction of pain was 7 points with the procedure and 2 points with the IV NSAID at 24 hours 12% in the injection group versus 50% in the IV NSAID group needed opioids 87% patient satisfaction in the injection group versus 16% patient satisfaction in the IV NSAID group References Tekin E, Gur A, Bayraktar M, Ozlu I, Celik...

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Podcast 713: Oral Ketamine show art Podcast 713: Oral Ketamine

Emergency Medical Minute

Contributor: Don Stader, MD Educational Pearls: Those on chronic opioid therapy may have high tolerance to opioids and/or opioid hyperalgesia Ketamine is a good adjunct for pain control in patients on chronic opioid therapy To avoid the time constraints often required to push ketamine intravenously, it can be given orally: Ketamine IV 25-50 mg (~0.01-0.03 mg/kg) as a single dose by mouth References Blonk M, Koder B, et al. Use of oral ketamine in chronic pain management: A review. European Journal of Pain. 2009. Schwenk ES, et al. Consensus guidelines on the use of intravenous ketamine...

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Podcast 712: Cephalosporin with a Penicillin Allergy show art Podcast 712: Cephalosporin with a Penicillin Allergy

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Retrospective cohort study in the Kaiser system looked at over 4 million patients receiving antibiotics to determine the effect of penicillin allergy prompts in the EHR on antibiotic prescribing Half of the sites removed prompts stating penicillin allergy and half kept the prompts Patients with penicillin allergies who received cephalosporins went up from 20% to 27% in areas where the prompt was remove No difference in mortality or no new allergies found between the two groups Reduced the use of fluoroquinolones and clindamycin in the group...

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More Episodes

Contributor: Dylan Luyten, MD

Educational Pearls:

  • Minnesota Tube has an extra port for suctioning otherwise is the same as a Blakemore Tube
  • Indicated in MASSIVE upper GI bleeding often due to esophageal varices
  • Esophageal varices are dilated, tortuous vessels in the esophagus due to increased portal venous pressure that can bleeding into the upper GI tract
  • Patients with massive upper GI bleed should be intubated prior to placing a Blakemore/Minnesota tube

References

Meseeha M, Attia M. Esophageal Varices. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448078/

Biecker E. Portal hypertension and gastrointestinal bleeding: diagnosis, prevention and management. World J Gastroenterol. 2013;19(31):5035-5050. doi:10.3748/wjg.v19.i31.5035

Powell M, Journey JD. Sengstaken-Blakemore Tube. [Updated 2021 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558924/

Photo from Wikimedia Commons

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

 

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