In HEMS, there are rare instances where ‘stay and play’ is the safest thing for the patient. Exsanguinating variceal bleed is one of those conditions. This week Dr. Whitford takes us step-by-step through the placement and confirmation of balloon tamponade placement (Minnesota Tube) for stabilization of these bleeds. We hope by reading this, it gives you another 6 months of this not happening on your next transport or ED shift...Read More
This week started with our monthly Morbidity and Mortality conference where we discussed posterior MIs, tough dissections and more tough cases. We then heard a debate on the use of D-Dimer in the diagnosis of aortic dissection. Finally, we were led through a simulation of a sick GI bleed requiring Minnesota tube placement, and we discussed optimal management of these challenging patients.Read More
This week Dr. Axelson took us through great DKA in pregnancy, hyponatremia tips, and prioritization in UGIB in this month's M&M. Critical Care bound Dr. Renne laid out some intra-arrest tips and Dr. Brown from Cincinnati Children's talked about Adult Congenital Heart Disease. Small groups covered everything from ACLS logistics to shoulder US to Minnesota tube insertion.Read More
Air Care Ground Rounds
Dr. Hinckley - Air Medical Resource Management
Familiarity and complacency can lead to mistakes. Stay uncomfortable. A policy for preflight walk-a-rounds will be released shortly.
E-poc blood gas analyzer is now on AirCare. Think about using it for all patients, but particularly those who are intubated or may be in a state of shock.
Dr. Powell - Minnesota Tube is coming to AirCare
Everything you need will be in the Critical Care bag. You can bring all the gear with you into the hospital without having to gather supplies there. No football helmet required.Read More
It is 2am on a cold, dark, winter night and you are dispatched to a small rural hospital to transport a patient by ground with a GI bleed back to UCMC medical ICU. Enroute dispatch notifies you that your patient has deteriorated and is profoundly hypotensive. The ED physician at the outside hospital is attempting intubation for airway control. On arrival you find a middle-aged male with all the classic stigmata of end-stage liver disease. More importantly he has a systolic blood pressure of 60 and a HR of 130. A literal fountain of blood spews from the patients mouth, around a successfully placed endotracheal tube, and is now beginning to pool on the floor. You know this patient needs massive resuscitation from his likely bleeding esophageal varices... but you are 55 minutes by ground to UCMC and know that your patient will not survive the transport unless something is done to control the bleeding...Read More