#emergency #emergencymedicine #criticalcare #icu #airway #medic #science #data #research #army #armymedicine #armyemdoc #trauma

So, either (a) you should be less worried about putting in an IO when you need vascular access, (b) you should rethink your stance on NG tubes, or (c) both.

Clip from The Pitt on @StreamOnMax

www.annemergmed.com/article/S019...

pubmed.ncbi.nlm.nih.gov/10339680/

PMID: 10339680

To that end, in the same study that assessed NG tube placement, NGT placement was rated by patients as more painful than ABG, abscess I&D, urinary catheter placement, fracture reduction, and lumbar puncture.

Comparatively, another study used the VAS to assess other common ED procedures. NG tube placement was rated at 46 out of 100mm... so, more painful. Yet, most of us probably do not think twice about ordering NG tubes.

In many cases, elective surgeries that could require blood were delayed until adequate supplies were available.

Clip from The Pitt on Max

pubmed.ncbi.nlm.nih.gov/35729854/

#emergency #emergencymedicine #criticalcare #icu #airway #science #data #research #army #armymedicine #armyemdoc #blood

This was most pronounced during early COVID when there was not only on-going demand for product (trauma, transplant and cancer never stopped existing), but donations were very scant with schools and business sources for blood drives dried up.

There is no good data on how often this happens, nor is there a standard threshold. This will often be a discussion between the surgical team, anesthesiologist, and the ICU team with the blood bank. The usual first step is that the blood bank will reach out to their supplier.

Larger centers are provided more products by the suppliers, which can be affected by things like trauma designation, transplant center status, etc.

Anecdotally, I was lucky enough to transfer out hemorrhaging patients from critical access facilities before exhaustion occurred. I'm sure others have been less lucky.

This usually only happens at large, tertiary care centers. Smaller hospitals often have very limited blood supplies on hand, so the response at those hospitals is to transfer the patient to the center with the larger supplies on hand, not bring in more supplies to the small hospital.

Essentially, it means that the blood bank is either going to run out of supplies or their supplies will become depleted to the point that it risks other patient care activities, usually the latter.