My Macgyver Moment

  Since emergency physicians are the MacGyvers of medicine – mullet not included – we asked our readers to send in their best stories of improvising on the fly. What did you do when you were fighting against the clock and couldn’t find the supplies you needed? Here are our four winning entries, with comments by Ken Iserson, MD, author of Improvised Medicine. Published entrants gain free admittance to Blood and Sand, a tropical CME in Atlantis, Bahamas. For a chance to win, send your best MacGyver Moment to lplaster@epmonthly.com Give Me a Hand(stand) by Andrew Langsam I was getting ready to go on a long-awaited dive trip to the great barrier reef. The week before the trip, I was flossing and popped out an amalgam which hit the roof of my mouth and then disappeared. Being an ER doc, I immediately suspected that it had wound up in my lung. I went to my ED radiologist and asked him to take a single view AP X-ray to confirm my suspicions. He assured me that I would be coughing if I had inhaled such an object, but he humored me and had his tech take the film anyway. Sure enough, there was a small, dense radiopaque foreign body in my left lower lung field on X-ray. I called my friendly pulmonologist and set up my bronchoscopy, bummed by the thought that having him mess with my lung might cause me to reconsider diving the next week in Australia. On day two, after the untimely aspiration, and the day before the scheduled bronchoscopy I had my MacGyver mo...
Source: EPMonthly.com - Category: Emergency Medicine Authors: Tags: Uncategorized Source Type: news

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A 60-something presented with hypotension, bradycardia, chest pain and back pain.She had a h/o aortic aneurysm, aortic insufficiency, peripheral vascular disease, and hypertension.  She had a mechanical aortic valve.  She was on anti-hypertensives including atenolol, and on coumadin, with an INR of 2.3. She was ill appearing.  BP was 70/49, pulse 60.A bedside echo showed good ejection fraction and normal right ventricle and no pericardial fluid. Here is the initial ECG:What do you think?This ECG actually looks like a left main occlusion (which rarely presents to the ED alive):  ST Elevation in...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Discussion Whether they’re “sensed” through difficulty in ventilating a patient manually via a bag-valve mask or noted because of a ventilator alarm, elevated airway pressures present a risk of harm to the patient. Many ventilators are set to not only alarm at certain airway pressures, but to alter the inspiratory flow delivered to a patient in order to avoid further elevations in airway pressure. This may result in a reduction in the tidal volume delivered to the patient and/or reduced minute ventilation, both of which may result in hypoventilation and resulting hypercapnia. This adjustment, which ventil...
Source: JEMS Special Topics - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Exclusive Articles Source Type: news
A 46-year-old woman presented to the Emergency Room, in September 2016, with left chest tightness and dyspnoea for hours, which was accompanied by pain radiating to her back, a non-productive cough, and sweating. Upon arrival the chest roentgenogram (CXR, Figure 1B) showed progressive left-side pneumothorax with mixed cystic and nodular lesions noted in both lungs compared with a baseline CXR from May 2014 (Figure 1A). She was in good health except for a history of uterine leiomyoma, which was treated with laparoscopic hysterectomy, at the age of 42 years.
Source: Heart, Lung and Circulation - Category: Cardiology Authors: Tags: Image Source Type: research
r F Abstract OBJECTIVE: The aim is to stabilize the thoracolumbar spine with a thoracoscopically implanted vertebral body replacement (VBR). To improve intraoperative depth perception and orientation, implantation is performed under three-dimensional (3D) thoracoscopic vision. INDICATIONS: Vertebral burst fractures at the thoracolumbar junction (A4 AOSpine classification), pseudarthrosis, and posttraumatic instability with increasing kyphosis. CONTRAINDICATIONS: Severe pulmonary dysfunctions, pulmonary or thoracic infections, previous thoracic surgery, and pulmonary adhesions. SURGICAL TEC...
Source: Operative Orthopadie und Traumatologie - Category: Orthopaedics Authors: Tags: Oper Orthop Traumatol Source Type: research
Conclusion EMS is in a position to be the initiator of specialty center destination. In large cities with multiple hospitals, EMS should transport patients to the closest, most appropriate facility based on patient condition, even if this requires passing a closer facility. Where there are hospitals with multiple specialty services, EMS may be asked to activate a specific team, such as the stroke or cardiac team. In rural communities, EMS can communicate with the local hospital and by letting the hospital know of patient condition, help start the interfacility transport process from the field....
Source: JEMS Special Topics - Category: Emergency Medicine Authors: Tags: Exclusive Articles Columns Operations Source Type: news
FDA has approved a new device intended to treat breathing difficulty associated with severe emphysema. The approval comes just two weeks after an FDA advisory panel shot down a competing technology targeting the same patient population. The agency approved Pulmonx Inc.'s Zephyr endobronchial valve through the breakthrough device designation, a pathway reserved for devices that provide for more effective treatment or diagnosis of a life-threatening or irreversibly debilitating disease or condition. Devices also must meet one of the following criteria: the device must represent a breakthrough technology; there must be no app...
Source: MDDI - Category: Medical Devices Authors: Tags: Regulatory and Compliance Source Type: news
The FDA today granted pre-market approval under its breakthrough devices designation to the Zephyr endobronchial valve made by Pulmonx for treating severe emphysema. Emphysema, a chronic obstructive pulmonary disease, causes irreversible damage to the lung’s alveoli, trapping air during exhalation that in turn can cause the diseased tissue to grow larger and pressure healthy lung tissue. The Zephyr device is designed to decrease the volume of the chest to improve function in the heart, respiratory muscles and healthy lung tissue. Inserted via bronchoscopy, the pencil-eraser-sized valves prevent air from ent...
Source: Mass Device - Category: Medical Devices Authors: Tags: Endoscopic / Arthroscopic Food & Drug Administration (FDA) Regulatory/Compliance Respiratory Pulmonx Source Type: news
Authors: Chu H, Kim J, Ha W, Cho E, Kang G, Park S, Jang J, Yang SB, Kang Y, Lee S, Kim JH Abstract Acupoint GB21 (Jianjing) is used for treating back and shoulder pain but is associated with a risk of pneumothorax. We aimed to determine the SND (safe needling depth) at GB21 according to posture and breathing in real time. Ultrasonographic images of GB21 during normal breathing, inspiration, and expiration in a SP (sitting position) were acquired for 52 healthy volunteers. Images were also acquired during normal respiration in the PP (prone position) with arms raised and lowered. The average SND was greater for men than for women (p
Source: Evidence-based Complementary and Alternative Medicine - Category: Complementary Medicine Tags: Evid Based Complement Alternat Med Source Type: research
AbstractChronic pain is a common medical condition. Patients who suffer uncontrolled chronic pain may require interventions including spinal injections and various nerve blocks. Interventional procedures have evolved and improved over time since epidural injection was first introduced for low back pain and sciatica in 1901. One of the major contributors in the improvement of these interventions is the advancement of imaging guidance technologies. The utilization of image guidance has dramatically improved the accuracy and safety of these interventions. The first image guidance technology adopted by pain specialists was flu...
Source: Current Pain and Headache Reports - Category: Neurology Source Type: research
​There is a saying, "Complexity in the face of adversity breeds chaos." I'm not sure where this maxim originated, but it is definitely true in resuscitation settings. That's the crux of this post: Is the abdominal tourniquet simplicity in the face of adversity compared with the resuscitative endovascular balloon occlusion of the aorta (REBOA)?​We all know how futile it feels to do CPR on a traumatic cardiac arrest patient with suspected massive blood loss. Just what are we pumping, and if there is any remaining intravascular blood, where are we pumping it?I will never forget the pain of trying to resuscitate ...
Source: M2E Too! Mellick's Multimedia EduBlog - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
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