I was drinking beers with my friend Oren Friedman, a medical intensivist with an interest in hypothermia; we got to talking about how it can be a PitA to pass the esophageal temperature probe for hypothermia. I had recorded some footage for our hypothermia video a while back on how to get er done.
Here is the reference mentioned:
Appukutty J, Shroff PP. Anesth Analg. 2009 Sep;109(3):832-5. Nasogastric tube insertion using different techniques in anesthetized patients: a prospective, randomized study.
Update: This new article adds a bougie to get the tube down the esophagus
Endotracheal tube-assisted orogastric tube insertion in intubated patients in an emergency department Oh. Sung Kwon, M.D. [10.1016/j.ajem.2014.11.004]
Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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Is nasopharyngeal temp probe the next best thing if esophageal temp probe isn’t available for purpose of therapeutic hypothermia?
Nope, nasopharyngeal is pretty useless. If you have a rectal prbe, then you have an esophageal probe; I have never seen one that is not for both sites. Just make sure you don’t go from rectal to esophageal without a probe change in between. If you had neither of these, bladder is the next best.
Thanks Scott…There is only rectal temp probe available at my shop.
Duncan,
Not sure I understand. If you take a cell phone pict of your probe, I am happy to confirm.
Hi Scott,
I use the same technique to get in the orogastric in the trauma patient. My only other tip is to use the scardest / most highly strung student / juniour MO you can find to do the “intubation” – 100% guaranteed to get ti in the oesopagus!!
Casey
too funny!!!!
Hey Scott,
At our hospital at Christiana – where you just recently visited – we actually use a temp foley. Your (or others) thoughts on that?
– Vik – one of the residents at lunch
Why do you slice/split/uni-valve the ETT?
so you can strip it off of the probe, otherwise the connecter end of the temp probe or the back of your ng tube prevents the ET tube from being pulled off the probe
How do measure the distance of the esophageal temperature probe? Tip of mouth to 2cm above the xyphoid or tip of mouth to ear to 2cm above the Xyphoid?
the latter
What is the knife that you use to split the ETT? I wouldn’t mind having one of those for use in the ED!
I have two:
Benchmade Rescue Hook
and
Boker Recom
A couple years ago we replaced our firm, moldable NG tubes with shitty limp ones that resemble esophageal temperature probes; often difficult to insert. Since then I’ve been using a similar method: 1. Cut an ETT lengthwise. I don’t carry a rescue hook so I use a scalpel, works much better than scissors/shears. 2. Perform laryngoscopy. 3. Place a bougie in the esophagus. 4. Railroad split ETT over bougie. Remove bougie. 5. Insert least expensive NGT in the world into ETT. 6. Withdraw ETT to end of NGT, then shed ETT using split. This method gives residents practice doing laryngoscopy… Read more »
just published: http://www.ajemjournal.com/article/S0735-6757(14)00793-1/abstract?
v. nice!
REmotely related question: What do you think should be done in case of Pulseless Electrical activity in hypothermia My understanding was these patients should receive cardiac compressions Uptodate now says : ” Although evidence is scant, we believe that chest compressions should not be performed in patients who manifest an organized rhythm on a cardiac monitor even if they have no palpable pulses and no other signs of life. Our reasoning is that such rhythms may reflect successful perfusion that could be disrupted by chest compressions, and that any pulseless electrical activity (PEA) is likely to be transient. There is little… Read more »
think they need an aline and if DBP<40 they need compressions
Thanks. ANd if no A. line available , just an ECG scope ?
great background music