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PSA: You *CANNOT* use a "bougie" or Eschmann Intubating Stylet to do an endotracheal tube exchange. I have seen this mistake twice in the past 6 months. You will lose the airway. A simple look at the length of the bougie and an #ETT will make this clear.
The length of an adult ETT is about 32 cm and the length of the #eschmannstylete is 70 cm. This leaves no room in the center for you to grab it. When you retract the #ETT to the end of the stylet, its distal tip is still in the patient's mouth & entire stylet is covered
To do a tube exchange, you need 2x the length of the ETT and then some additional length to work with, else you risk retracting the exchange device too far and losing the airway. This is why they make an "airway exchange catheter" and its length is 83cm:…
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1/ So now it's the cataclysmic TTM -2 trial, just published in @NEJM. How can a world changing trial like HACA published in 2002 now be effectively reversed almost 20 years later? I will explain.…
2/ Lots of head scratching. Hard to understand. But I am not surprised. It's a pattern that we have seen before with goal directed therapy for sepsis and intensive insulin therapy for hyperglycemia. The answer is that a trial's results depend very much on the clinical milieu
3/ When Manny Rivers published his EGDT classic in the @nejm in 2001, the milieu was bad sepsis therapy. The control group was neglected, under-resuscitated, anemic nursing home patients. I remember these shocky patients in the in ER those days, waiting for hours for an ICU bed.
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