EM Quick Hits 40 – GI Balloon Tamponade, SVT and Troponin, Falls in Older Patients, Vertical Vertigo, VAFEI Airway

Topics in this EM Quick Hits podcast Anand Swaminathan on GI balloon tamponade preparation and indications (1:30) Jesse McLaren on why troponin is rarely useful in SVT (8:45) Christina Shenvi on why we should not use the term "mechanical fall" in older patients (15:25) Nour Khatib & Jonathan Wallace on rural vertical vertigo case (25:24) Reuben Strayer on VAFEI - Video-Assisted Flexible Endoscopic Intubation (32:56) Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Reuben Strayer & Anton Helman Cite this podcast as: Helman, A. Swaminathan, A. McLaren, J. Shenvi, C. Khatib, N. Wallace, J. Strayer, R. EM Quick Hits 40 - GI Balloon Tamponade, SVT and Troponin, Falls in Older Patients, Vertical Vertigo, VAFEI Airway. July, 2022. https://emergencymedicinecases.com/em-quick-hits-july-2022/. Accessed September 17, 2024. GI balloon tamponade preparation and indications * Employ mental preparation with deliberate practice well before the procedure * If your ED does not have a GI balloon tamponade kit with all the necessary gear, consider getting involved in creating one for your ED * Airway control is usually necessary before placing the GI balloon * Potential indications for placing GI balloon tamponade before the patient decompensates include: * Recurrent hemodynamic instability * Activation of massive transfusion * Recurrent or active hematemesis * Delay to endoscopy Overview of Linton, Blakemore and Minnesota GI tube video Placement of Blakemore tube video Placement of Minnesota tube video Placement of Linton tube video Expand to view reference list * Bridwell RE, Long B, Ramzy M, Gottlieb M. Balloon Tamponade for the Management of Gastrointestinal Bleeding. J Emerg Med. 2022 Apr;62(4):545-558. * Morgenstern, J. Balloon tamponade of GI bleeding, First10EM, May 23, 2016. Available at: https://doi.org/10.51684/FIRS.2147 Is there any value in troponin for SVT? * Evidence suggests that troponin testing in patients with paroxysmal SVT who present to the ED with an episode of SVT does not improve outcomes and may increase length of stay, admission rates and increase potentially harmful downstream testing * The palpitations and chest pain in patients with SVT are rarely symptoms of ACS * ST depression in multiple ECG leads is common in SVT and is thought to be rate related/demand ischemia unless it persists after cardioversion; when the ST depression resolves after cardioversion this confirms the diagnosis of SVT and essentially rules out ACS as a cause of ST depression * The pathophysiology of SVT is sufficient to explain a bump in troponin without the presence of CAD * The prognosis of SVT is not significantly changed with an elevated troponin level compar...