This lecture was from the final day of SMACC 2013. It was based on a case I saw at Janus General Hospital.
[vimeo 76743429 w=620]Blakemore Placement
In the lecture I talk about a life-saving Blakemore Tube placement. I suspect some of you may need a reminder of the intricacies of this device, so I made a video and cheat-sheet.
Now on to the Podcast…
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Scott Weingart
An ED Intensivist from NY. No conflicts of interest (coi).
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Enjoyed the talk. Although with regard to Interventional Radiology coming in, the reality in NYC this usually goes something like this: The hospital administrator calls a private transport company and you show up to an “unknown” to an aftermath to find a patient with devices in them you never seen in your life and there is usually no one there expect one nurse who is very busy and is rushing you out the door before you even walk in. Your request to speak with an attending gets you an intern who has no clue of what is going on as he rummages through 10 pages of notes of all the patients he has, to then tell you information you already know just by looking at the patient “it’s a GI bleeder, where do you want me to sign”.
Nikolay, Not sure I understand. Are you an interventional radiologist speaking about coming to outside hospitals.
No, I am the paramedic who will transport the patient to a tertiary referral hospital where the IR who can perform the procedure will actually see them.
I think I must of been unclear in how I presented the case.
It was clearly presented. However finding IR that is willing to come to another facility is a rarity rather than the norm. From my experience such patients are usually transferred to the facility where the are able to undergo the procedure.
ahh, ok now i get it. agree.
Hi Scott,
Am a relatively new listener getting through the backlog of your podcasts. Really really enjoy them and agree with most of what you say :). Fantastic guests. Possible suggestion: mention the date on podcasts so we can determine how new/old the podcasts are when listening.
RE the massive GI hemorrhage case I know you are familiar with the Villanueva study (NEJM, 2013) and though not applicable to your patient might be of interest to your audience. Also, I am aware of the body of literature using TXA for GI bleeds (no ‘s’ in ‘tranexamic’ ;)) and this is a reasonable approach I think. The goodness that is TXA is also its weakness – it’s not very potent but thus also has few side effects. In this condition would you consider a 3- or 4- factor concentrate instead? Not much literature on this but more effective I’d imagine. Note the advisory against using the 2 together (we recently had a death with AMICAR + Profilnine). Without the benefit of a TEG I’d assume that as liver failure maybe repletion via factor concentrate might be more effective.
Anyway, wonderful stuff. Thanks
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