Sarab Sodhi, MD
Have you cared for a paient dying from traumatic hemorrhagic shock despite maximum resucitation efforts? Dr. Zaffer Qasim from Christiana Care and @emmeddoc joined us for an outstanding talk on the use of REBOA in this patient population.
Case: A 68 year old woman presents to the ED with fever, hypotension, and AMS. She has a PICC in place. Your overzealous intern places a central line, and he swears the stick was venous. You obtain and CXR to confirm line placement. Where does the line terminate?
Answer: B. It is venous but extends to the right brachiocephalic vein. The central line is inadvertantly deep and likely resulted from the guidewire being displaced by the patient's PICC line. This patient will need the line removed/replaced.
Estimated Central Line Lengths for Correct Placement:
Right Internal Jugular Vein: 13 cm, +/- 2 cm
Right Subclavian Vein: 15 cm, +/- 2 cm
Left Internal Jugular Vein: 15 cm, +/- 2 cm
Left Subclavian Vein: 17 cm, +/- 2 cm
Case: An 8 year old girl presents to the Emergency Department with the feeling of shortness of breath. Onset was soon after a meal and her parents state that she may have choked on something.