Brought to you by: Priya Ghelani, Brian Gilberti and Maninder Singh
Chest tubes– Dr. Bhargava
– Triangle of safety; landmarks: mid-axillary line, 4th-5th ICS, above rib
– Point kellys downwards to get into the cavity prior to turning upwards to feed tube
– Verify you are in the pleural cavity prior to tube insertion
– PTX can be mistaken for bullae on XR; if you are unsure and the patient is stable get further imaging
– Confused about air leaks? www.icufaqs.org/ChestTu
– Dr. Bhargava is open to residents coming to the OR to place chest tubes if you want to practice before your patient in extremis comes in the ED
EBM: FAST US Examination as a Predictor of Outcomes after Resuscitative Thoracotomy, Inaba et al– Dr. Moronta
– Cardiac motion on FAST was 1200 sensitive and 73.7% specific for the identification of survivors and organ donors
– Addition of pericardial effusion did not improve sensitivity for the identification of organ donors
– Take home point: All survivors and organ donors had visible cardiac motion on FAST. If no cardiac motion or pericardial effusion was seen on FAST, then survival was zero.
How to Run a Code– Dr. Santavicca
https://www.emrounds.org/dont-
– Cardiac perfusion pressure correlates w/ ETCO2
– Early shock critical for appropriate rhythms
– Don’t stop compressions to intubate; bagging/supraglottic devices should be used more often in codes
– As the leader of a code, do no procedures- you are the leader
– Ask a lot of questions (How much time between epis? Is it difficult to bag? Do you need someone to switch with you for compressions?)
Red Eye– Dr. Bassi
https://www.youtube.com/watch?
– Discharge (mucopurulent VS watery VS none) can help distinguish between bacterial VS viral VS allergic conjunctivitis
– When treating bacterial conjunctivitis, make sure to ask about contact lens use as the antibiotics differ
Lateral canthotomy– Dr. Walker
https://www.youtube.com/watch?
– EMRAP video: https://www.youtube.com
Lung Ultrasound to assess for PTX– Dr. Sun
https://www.youtube.com/watch?
– For stable patients with penetrating trauma to the torso, always perform an E-FAST as an adjunct after primary survey
-Air rises to the top in PTX so in a supine patient scan both sides of the anterior chest and first look for the bat/frog sign (two ribs separated by the horizontal pleural line) and then for lung sliding in B mode / seashore sign in M-mode to reassure you there is no large PTX
-If you see a “barcode sign” on m-mode, there is a high probability of PTX. Lung point (pleural movement against motionless pleura) on B-mode is 100% specific for PTX
Undifferentiated Dypsnea– Dr. Halperin
https://www.youtube.com/watch?
-The “triple scan” – heart, lung and IVC US can improve diagnostic accuracy in undifferentiated dyspnea in the ED
SAH Decision Rules– Dr. Campbell
https://www.youtube.com/watch?