Clinical Practices

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I recently spent a month with our colleagues in the MICU. Our team placed a fair number of arterial lines and I picked up a few tips that I thought were worth sharing. We don’t place a-lines very often in the ED, but it’s worth considering if you’re going to be boarding a MICU patient who is in shock. Arterial lines can also be useful if your non-invasive cuff pressures seem unreliable or you’re giving vasoactive medications that benefit from careful titration based on BP (i.e. Nicardipine). If you find yourself placing an arterial line in the future, here are some troubleshooting tips to help you succeed.

 

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The subject of this Clinical Practices is the modified valsalva maneuver popularized by the REVERT Trial . Many of you may already be aware of this modification, as the study was published in October of last year. I’ve had a lot of success with this modified valsalva over the past several months during my Yale ED blocks and I want to make sure our residents are aware of this and using it for hemodynamically stable SVT patients. I’ve never had a patient convert with the “just bear down like you’re having a bowel movement” technique and I love having this standardized approach in my back pocket.

 

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YaleEM.org is pleased to introduce a new reoccurring post called Clinical Practices. The goal of the post is to quickly highlight an interesting technique that you might consider using on your next shift. The subject of this Clinical Practices is the use of ultrasound to confirm endotracheal tube placement during intubation.

 

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