Podcast 1026: Esophageal Balloon Tamponade Devices
Emergency Medical Minute
Contributor: Jeffrey Olson, MD Educational Pearls: What are they? A flexible balloon and suction tube that we insert into the esophagus and into the stomach to stop bleeding. When to use? Typically used for variceal bleeding. Use whenever the patient is too unstable to be transferred to more definitive therapy. What are the different types? Linton - Nachlas Tube Single gastric balloon with a suction port for the stomach and sometimes a suction port for the esophagus. Sengstaken - Blakemore Tube Gastric balloon and esophageal balloon with only a gastric suction port ...
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Podcast 1025: Post intubation Sedation
Emergency Medical Minute
Podcast 1025: Post intubation Sedation Contributor: Aaron Lessen, MD Educational Pearls: Experts suggest that anyone who is put on a ventilation should be given sedation. When acquiring Rapid Sequence Intubation (RSI) medications and kits, one should also plan their sedation strategy and always consider the patient becoming unstable hypotensive after their intubation. References Needleman R, Dyer S, Martinez KA, Routsolias JC. Optimizing administration and timing of post intubation analgesia and sedation in the Emergency Department. Journal of Emergency Nursing....
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Podcast 1024: Caffeine Toxicity
Emergency Medical Minute
Contributor: Taylor Lynch, MD Educational Pearls: Excessive caffeine intake can be dangerous. For normal adults, the toxicity level starts at 1000mg, which is equivalent to about 10 cups of coffee or 5 celsius drinks. For normal adults, lethal levels are about 5-10 grams, which is equivalent to about 50-100 cups of coffee. Most of these outcomes are not from drinking caffeine, but instead concentrated caffeine pills. For children, toxic levels are 15mg per kg of the child. Within the last 10 years 20-40 deaths due to caffeine intake have been reported. This...
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Podcast 1023: Torsades de pointes
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Case review of a patient with recurrent episodes of syncope and shortness of breath, during which she is found to have intermittent runs of polymorphic ventricular tachycardia Torsades de pointes is polymorphic ventricular tachycardia occurring in the setting of a prolonged QT/QTc Risk of torsades increases substantially when QTc exceeds 500ms Causes: Common reversible causes include QT-prolonging medications, hypokalemia, hypomagnesemia, hypocalcemia, bradycardia, and structural heart disease Congenital causes of a prolonged QT...
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Podcast 1022: Emergent Dialysis
Emergency Medical Minute
Contributor: Taylor Lynch, MD Educational Pearls: When a patient who missed dialysis presents to the emergency department, our clinical concern is who needs to be admitted to the hospital for emergent dialysis and who can wait for their next regularly scheduled session. Dialysis sessions typically occur on Monday, Wednesday, and Friday, or Tuesday, Thursday, and Saturday. Acronym for indications for emergent dialysis: AEIOU Acidosis Patients may have an underlying cause for acidosis such as sepsis or DKA. Treat the underlying cause, but if the acidosis is unable to be...
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Podcast 1021: Pulmonary Edema From Naloxone Administration
Emergency Medical Minute
Contributor: Travis Barlock, MD Educational Pearls: What is pulmonary edema? Pulmonary edema is the accumulation of fluid initially in the interstitium of the lungs, that when severe enough can also accumulate in the alveolar air sacs. It develops when the rate of fluid filtration through the pulmonary vasculature out-paces the lymphatics ability to drain the fluid. There are 2 theories for what causes pulmonary edema in the setting of naloxone administration: catecholamine surge vs negative pressure/barotrauma Catecholamine Surge : Naloxone administration precipitates an...
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Podcast 1020: Benign Paroxysmal Positional Vertigo (BPPV)
Emergency Medical Minute
Contributor: Alec Coston, MD Educational Pearls: Benign Paroxysmal Positional Vertigo (BPPV) Common inner ear condition that can cause dizziness Diagnosis of BPPV can help to avoid admissions and extra imaging Three categories: positional, horizontal, and anterior Positional is the most common Dizziness is not a positive indicator, a torsional nystagmus must be induced Dix's hallpike maneuver is done to diagnose and an epley maneuver is then used for treatment Horizontal Usually determined to be the case if the vertigo seems positional and the dix...
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Podcast 1019: Trauma Blunt Cardiovascular Injuries (BCVI)
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Blunt cerebrovascular injury (BCVI) BCVI is a traumatic injury to the carotid or vertebral arteries Patients may initially have no neurologic symptoms In some cases, a thrombus can form at the site of the injury and later cause ischemic stroke, sometimes hours after the original trauma CT angiography (CTA) of the neck is a useful screening tool for BCVI HIstorically, CTA was reserved for patients with high-risk mechanisms or neurologic symptoms CTA screening has expanded as understanding of BCVIs and their prevention...
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Podcast 1018: Occult Ventricular Fibrillation on Echocardiography
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Big question in cardiac arrest: is the rhythm shockable? Shockable: ventricular fibrillation (VF) and pulseless ventricular tachycardia Non-shockable: asystole and pulseless electrical activity (PEA) Rhythm classification is typically based on ECG, but echocardiography can directly visualize myocardial fibrillation Occult VF: a rhythm that appears non-shockable on ECG but demonstrates VF on echocardiography A 2025 multicenter prospective study looked at 811 patients with out-of-hospital cardiac arrest 5.3% had occult VF...
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Podcast 1017: CPR Hand Placement
Emergency Medical Minute
Contributor: Taylor Lynch, MD Educational Pearls: CPR is an important life-saving measure designed for anyone to perform. Chest compressions works by two mechanisms: Cardiac pump: Direct squeezing of the heart Thoracic pump: Increasing intrathoracic pressure, causing increased blood flow Proper hand placement per current AHA guidelines: Hands are placed in the center of the chest, on the lower half of the sternum A recent study challenged this approach, using TEE during chest compressions to visualize the cardiac structures being compressed. They found...
info_outlineContributor: Taylor Lynch, MD
Educational Pearls:
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CPR is an important life-saving measure designed for anyone to perform.
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Chest compressions works by two mechanisms:
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Cardiac pump: Direct squeezing of the heart
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Thoracic pump: Increasing intrathoracic pressure, causing increased blood flow
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Proper hand placement per current AHA guidelines:
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Hands are placed in the center of the chest, on the lower half of the sternum
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A recent study challenged this approach, using TEE during chest compressions to visualize the cardiac structures being compressed.
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They found that when hands were placed ~1cm to the left of the sternum, this compressed the left ventricular outflow tract, potentially restricting forward blood flow.
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Hand placement ~4cm to the left of the sternum resulted in more effective compression of the left ventricle.
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While this is not yet reflected in AHA guidelines, the study presents an interesting finding that may influence how CPR is performed in the future.
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Key takeaway: Always prioritize administering high quality compressions.
References:
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American Heart Association. 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(23_suppl_1). doi:10.1161/CIR.0000000000001378.
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Chu S, Cheng C, Chang C, et al. Transesophageal echocardiography during CPR in patients with out-of-hospital cardiac arrest: the EXECT-CPR randomized clinical trial. JAMA Intern Med. 2026;186(5):557-566. doi:10.1001/jamainternmed.2026.0102.
Summarized by Ashley Lyons, OMS4 | Edited by Ashley Lyons & Ahmed Abdel-Hafiz, NREMT-P
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