Oops…is that part important?

    NextPrevious

    Oops…is that part important?

    There you were, minding your own business when EMS brings you a sick-as-can-be patient, intubated in the field for who knows what. Someone gets overzealous with their trauma shears and cuts off the pilot balloon on the endotracheal tube.

    This happened to me twice in my PGY2 year.

    Obviously, this ETT will need to be exchanged, but what is your strategy for temporizing the patient that really was on the edge of life and death, needing every last mL of tidal volume, every cmH2O of PEEP?

    To buy yourself all the time in the world, you need three items, all readily available in your average emergency department:

    1. 20 gauge angiocath
    2. Three way stopcock
    3. 10 mL syringe

    A 20 gauge angiocath will fit perfectly in the balloon tubing of any standard ETT, regardless of the ETT diameter. If you attach a three way stopcock to this, you have just bought yourself the ability to reinflate the cuff, reoxygenate the patient, and all the time you need to safely exchange the tube.

    If you don’t have a three way stopcock at hand, you can use the 20 gauge angiocath to inflate, and then use a pair of Kellys or locking needle drivers from a suture kit to pinch off the tubing and hold the seal.

    I’ve used this. It works. Keep it in your mental back pocket.

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • renal handling of water

      If you were on a tea & toast diet, how much water would you need to drink before you develop hyponatremia? I haven’t seen anyone work out the numbers before so here are my calculations. AndRead more

    • acute acidemia physiology

      As alluded to in the first post, don’t be fooled by a “normal” potassium in the setting of DKA because osmotic diuresis and H+/K+ exchange means that total body potassium is actually LOW. You all knowRead more

    • renal handling of potassium

      the first symptom of hyperkalemia is death Earlier post covered temporizing measures to counter hyperkalemia — namely, intracellular shift, increasing cardiac myocyte threshold potential. Give furosemide if the patient still urinates and consider dialysis, but then askRead more

    • bicarbonate revisited

      Previous post reviewed the safety of balanced crystalloids in hyper K. But what was up with serum bicarbonate decreasing with saline administration? This post introduces a new way of looking at the anion gap to possiblyRead more

    • hyperkalemia and balanced crystalloids

      Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium toRead more

    • hyperkalemia physiology

      You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buffered byRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Otitis externa: use the ear wick!

      Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear”Read more

    NextPrevious