Profile picture
, 4 tweets, 2 min read
My Authors
Read all threads
Massive variceal bleed and no EGD at your hospital?

Be ready to place a blakemore/balloon tamponade device in uncontrolled variceal hemorrhage.

Tips from prior cases

#foamcc
#foammed
After ABC's...

1. Place the device like an OG

2. Check position by xray (may need little air ~50 ml in balloon to see)

3. Inflate gastric balloon with ~ 250 mL air

4. X ray

Don't over inflate

👇

Image: overinflated and improperly positioned causing gastric distension 😯
Deflated & repositioned w/ balloon at the GE junction to tamponade the variceal origins

Apply light traction w/ kerlix->IV pull->1 L fluid
Use esophageal balloon only if gastric doesn't control bleed-more complication risk w/ esoph balloon must use manometer (ET tube cuff manometer works convert cm H20 to mm Hg) & keep balloon pressure < 30-45 mmHg
Missing some Tweet in this thread? You can try to force a refresh.

Enjoying this thread?

Keep Current with Skyler Lentz

Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

Twitter may remove this content at anytime, convert it as a PDF, save and print for later use!

Try unrolling a thread yourself!

how to unroll video

1) Follow Thread Reader App on Twitter so you can easily mention us!

2) Go to a Twitter thread (series of Tweets by the same owner) and mention us with a keyword "unroll" @threadreaderapp unroll

You can practice here first or read more on our help page!

Related hashtags

#foamcc #foammed

More from @SkylerLentz see all

Profile picture
Skyler Lentz
@SkylerLentz
Tips on the mechanically ventilated ARDS and sick hypoxemic patient.

Protect the lungs from the start! See the basics below.

#Tweetorial #foamcc #foamed

Based on prior work with @mattroginski @roo_atchinson

@UVM_EM

1/
What is the definition of ARDS?

The Berlin criteria: Acute onset within one-week, bilateral opacities on CXR not explained by cardiogenic pulmonary edema, pleural effusion etc. and a PaO2/FiO2 ratio of <300 mm Hg with PEEP 5 cm H2O.

jamanetwork.com/journals/jama/…

2/
More simply in the ED or acute setting I consider anyone with bilateral infiltrates + inflammation (sepsis, pneumonia, trauma etc) + hypoxemia to be at risk for ARDS and if intubated manage them with lung protective ventilation.
3/
Read 16 tweets
Profile picture
Skyler Lentz
@SkylerLentz
You intubated the asthmatic! What to look for on the vent and what to do about it.

It gets complicated, but the basics are in the thread below

#foamcc #foamed #tweetorial mini
1/
The problem is bronchospasm and secretions narrow the airways and lead to obstruction, limitations in exhalation and high airway resistance.

On the vent, this is seen as a high peak pressure (high resistance) and a prolonged expiratory flow or incomplete exhalation.
2/
The high peak pressure isn’t really a problem unless the plateau (obtained by an end insp hold) is also high. The delicate alveoli only feel the plateau pressure. Best to keep the plateau pressure < 30 cm H20 by minimizing auto-PEEP as the auto-PEEP contributes to plat press
3/
Read 11 tweets

Embed code for your website

×
Follow Us on Twitter!

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!