Just did an interesting case that I would like to share with you guys. 86 y/o with 8.5 cm ruptured AAA shows up emergently to the OR with 18G PIV with one minor twist, he is Jehovah's witness 😀 . Any thoughts !!
Just did an interesting case that I would like to share with you guys. 86 y/o with 8.5 cm ruptured AAA shows up emergently to the OR with 18G PIV with one minor twist, he is Jehovah's witness 😀 . Any thoughts !!
Just did an interesting case that I would like to share with you guys. 86 y/o with 8.5 cm ruptured AAA shows up emergently to the OR with 18G PIV with one minor twist, he is Jehovah's witness 😀 . Any thoughts !!
This guy was okay with cell saver and Albumin. My experience with ruptured AAA is limited and I was wondering it it is better to put the cordis in after induction/intubation or pre-induction ( to minimize the time between induction and aortic cross clamp) ? Also, would u guys consider starting the case without central access if you have enough peripheral access ?
This guy was okay with cell saver and Albumin. My experience with ruptured AAA is limited and I was wondering it it is better to put the cordis in after induction/intubation or pre-induction ( to minimize the time between induction and aortic cross clamp) ? Also, would u guys consider starting the case without central access if you have enough peripheral access ?
sounds like you had a borderline JW.
Also, would u guys consider starting the case without central access if you have enough peripheral access ?
Anyone gone on bypass with a 16 gauge? 😱
Been there during a thorocotomy gone bad. It was a first and hopefully last.
line 'em up before.... when the belly opens things are likely to get a whole lot worse fast... if they are meta-stable its only because they are meta-tamponaded
Lines aren't always a slam dunk, especially if they are in hypovolemic shock.
you need to be willing to adapt.
Interesting. I am writing a case of a ruptured aaa in a jehovah witness patient. The surgeons chose to do the case endovascularly. Pt survived the procedure but expired in the Icu.
Call me whatever you would like, but a ruptured AAA in an 85 y/o should be no more than a morphine drip. We cant expect everyone to live forever. Surgery is no more than $100,000+ later with the same outcome
Don't forget your best friend the RIC. Who needs a ****in cordis?
Get into that belly and get it under control ASAP.
- pod
This guy was okay with cell saver and Albumin. My experience with ruptured AAA is limited and I was wondering it it is better to put the cordis in after induction/intubation or pre-induction ( to minimize the time between induction and aortic cross clamp) ? Also, would u guys consider starting the case without central access if you have enough peripheral access ?
I just came back to post about the RIC and you all beat me to it ...
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Great for converting those ER-special 20 g antecubitals to something big. Wire won't fit through a 22 g, ask me how I know.
Never seen one blow though ...
RICs are the bomb.
Due to a shortage of cortis kits (don't get me started on this one) and more RICs than I knew what to do with, we have been using them quite a bit. We started getting our RNs trained to put them in. That was nice, roll back to the OR for a big case, just say I want a RIC and hook it up to the belmont. Big access and volume flies in.
your RNs put RICs in? Wow! Ours can barely put IVs in...
drccw
your RNs put RICs in? Wow! Ours can barely put IVs in...
drccw
Call me whatever you would like, but a ruptured AAA in an 85 y/o should be no more than a morphine drip. We cant expect everyone to live forever. Surgery is no more than $100,000+ later with the same outcome
What does RIC stand for? Is it just a peripherally inserted short cordis?
no offense, but i wouldnt trust a RIC that I hadnt put in myself or witnessed being put in by someone i know.
RICs can handle 1500ml/min, based on the package insert, which is more than a MAC or an introducer. ive also experienced that the blood volume can return to you just as quickly when i removed the stylet before I was ready to hook up the lineonly do that once...
I'm in a special place right now with a special population. 🙂
Call me whatever you would like, but a ruptured AAA in an 85 y/o should be no more than a morphine drip. We cant expect everyone to live forever. Surgery is no more than $100,000+ later with the same outcome
Don't forget your best friend the RIC. Who needs a ****in cordis?
Get into that belly and get it under control ASAP.
- pod
I just came back to post about the RIC and you all beat me to it ...
![]()
Great for converting those ER-special 20 g antecubitals to something big. Wire won't fit through a 22 g, ask me how I know.
Never seen one blow though ...
A good point worth raising. Einstein didn't have his fixed.
Debakey did though. Interesting story. http://www.nytimes.com/2006/12/25/health/25surgeon.html
I was taught you had to have an 18g for a RIC, didn't know the wire would fit through a 20g. Very nice.
I can only imagine how much damage you could do with an infiltrated RIC, though! Yikes!
Ahh I see the special place and popuation now. Stay safe....
No introducers but belmont machines? I'ld rather have a belmont......
My buddy did some time in Iraq... their rapid infusers were strong able bodied corpsmen...
drccw
I just came back to post about the RIC and you all beat me to it ...
![]()
Great for converting those ER-special 20 g antecubitals to something big. Wire won't fit through a 22 g, ask me how I know.
Never seen one blow though ...
I'd like to see the EZ IO become an accepted method for rapidly securing central access. Zzzzip.
The infusion rates on these are pretty low though. Pharmacokinetic studies seem to suggest time-to-central times are good.
Don't forget your best friend the RIC. Who needs a ****in cordis?
Get into that belly and get it under control ASAP.
- pod
TEE = waste of time.
What is it going to tell you that you don't already know/ can't deduce easily?
Hypotension is either going to be from volume depletion or lethal anemia. When they cross clamp the aorta his afterload is going to go up and when they release it it is going way down and he will be empty.
Either way, TEE isn't going to make a difference in outcome.
Honestly, I would be willing to do this case with a couple of PIVs, a BP cuff, and a couple of fingers on the radial pulse.
I would prefer an A-line for post-op management and to free up my hand from palpation during the case, but I wouldn't waste a lot of time getting it before they open the belly and get definitive control.
If he was not a Jehovah's Witness, an a-line would be more helpful (for HCT). I would waste a fair amount of time trying to get it in. I still don't see the TEE being helpful.
But then again, I am still pretty junior at all of this.
- pod