J Emerg Med
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Balloon tamponade of esophagogastric variceal hemorrhage is a lifesaving but challenging procedure. One difficulty that often arises is coiling of the tube in the oropharynx. We describe a novel use of the bougie as an external stylet to help guide placement of the balloon to help overcome this challenge. ⋯ The bougie may be considered as an adjunct for placement of tamponade balloons for massive esophagogastric variceal hemorrhage when placement proves refractory to traditional techniques. We think this can be a valuable tool in the emergency physician's procedural repertoire.
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Observational Study
Interrater Reliability of Point-of-Care Cardiopulmonary Ultrasound in Patients With Septic Shock: An Analysis of Agreement Between Treating Clinician and Expert Reviewers.
Cardiopulmonary ultrasound (CPUS) is commonly used to assess cardiac function and preload status in patients with septic shock. However, the reliability of CPUS findings at the point of care is unknown. ⋯ Our study demonstrated high IRR for preload volume parameters (IVC size and presence of B-lines), but not for cardiac parameters (LV function and RV function and size) in patients presenting with concern for septic shock. Future research must focus on determining sonographer and patient-specific factors affecting CPUS interpretation in real-time.
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Needle aspiration is a common treatment of peritonsillar abscess (PTA). Point-of-care ultrasound (POCUS) can be used to guide this procedure. We describe our experience using a commercially available needle guide attached to an endocavitary ultrasound probe for dynamic real-time POCUS-guided PTA needle aspiration. ⋯ The needle guide is a useful adjunct to assist in PTA drainage. It provided rapid, safe, and efficient care. Additional research is needed to see how this technique compares with more traditional methods of PTA drainage.
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Although naloxone has proven to be an effective opioid reversal agent, concern that high doses of naloxone can cause pulmonary edema may prevent health care providers from administering it in initial high doses. ⋯ Study results suggest that the reluctance of many health care providers to administer larger doses of naloxone on initial treatment may not be warranted. In this investigation, there were no poor outcomes associated with an increase in naloxone administration. Further investigation in a more diverse population is warranted.
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Comparative Study
Comparison of Rigid and Articulating Video Stylets During Simulated Endotracheal Intubation With Hyperangulated Video Laryngoscopy.
Endotracheal tube delivery through the vocal cords can be challenging with hyperangulated video laryngoscopy due to the acute angle around the tongue and surrounding airway structures. Articulating video stylets may mitigate this issue by equipping an endotracheal tube stylet with an operator-controlled articulating end that has an additional camera at the tip. ⋯ During simulated endotracheal intubation, the rigid and articulating video stylets had similar operator-reported ease of intubation.