Cite this post as:
Scott Weingart, MD FCCM. A Wee Bit More on Massive Hemoptysis. EMCrit Blog. Published on July 31, 2017. Accessed on February 3rd 2023. Available at [https://emcrit.org/emcrit/wee-massive-hemoptysis/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: July 31, 2017
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Great MacGyver..manuevers.
Need to rehearse them in the simulation lab.
Harder to get double lumen endotracheal tubes in my resuscitation bay.
These are acute immediate life-threatening unusual situations. Please escort Dr. MacGyver to the exit door. If DLTs, costing approximately $85 CAD each, are hard to come by in your ED, ask for the anesthesiologist to bring down one for you, or order a couple. Have the best most experienced person insert it. 37L fits most. IMHO, there is no place for ‘this may work’ strategies in the drowning patient.
Build it…and they will come. I’m going to build the “PumlCrit SALAD” modifications for us to simulate this on an airway mannequin for Oren (he has a course we’ll run it at Sept. 11th at Cedars-Sinai(. Video, photos, and laughter to follow.), We will try the 4.0 microlaryngeal tube with a 7.5 or even 8,0 in the mannequin, then bronch away. Hopefully I’ll get the largest Ambu Ascope endoscope for this demonstration (hopefully it’s suction and working channel can be up to the job). 15 fr bougie and 10 fr bougie needed (they can both fit down an existing ETT… Read more »
sweeeeet!!
In the podcast you mention that double lumen tubes are crap. Why? They work great for lung isolation. Disclosure – I’m an anesthesiologist. BTW, just found the podcast recently. I love it and I’m learning a ton!
Can you give some more info on the return of the lightwand? Who will be producing it and when?
I work in a rural setting without any specialist on site, no bronchoscope, and transport to high level care is about 1 hour drive. Do you think that after lung isolation with double tube technique (whether cric + supraglottic, or both supraglottic), a whole lung lavage with iced water could be tried via the appropriate ETT ? Pubmed shows descriptions in the cases of pulmonary alveolar proteinosis where 40-50L are flushed. So feels like doing a 1L flush in ER would be feasible.
doesn’t strike me as a great idea. prob better off neb some txa through the tube to the bleeding side