Trick of the Trade: Chest tube rewarming with Foley tubing connector

You have a pulseless hypothermic patient requiring aggressive internal rewarming. ECMO is not available, and you’ve made the decision to initiate thoracic lavage. After placing your chest tubes, you step back triumphantly, but in short order, the nurse hands you large diameter IV tubing with warmed fluids so that you can connect it to the chest tube. You are left with the IV tubing in one hand and a chest tube in the other with no time to waste, but no elegant or straightforward solution to interface the two.

Trick of the Trade

Using Foley bag tubing

The tube from a standard Foley bag, available in all emergency departments, contains a Luer lock near the tapered nozzle. This unique connector setup allows you to instill warm fluids into the thoracic space with minimal spillage.

rewarming hypothermia IV tubing chest tube foley tubing

Technique for Rewarming

  1. Attach the warmed IV fluids to the Luer lock port on the Foley bag tubing.
  2. Insert the tapered nozzle on the Foley bag tubing (typically interfaces with the urine drainage port of the Foley catheter) into the chest tube.
  3. Clamp the remainder of the Foley bag tubing just proximal to the Luer lock to minimize backflow of IV fluids into the bag.
  4. Optional: Cut the tubing proximal to the clamp to declutter the space around the interface.
  5. Instill warm fluid through one chest tube and drain it from the adjacent chest tube.
  6. Continue rewarming resuscitation protocols.
Chest tube connected to IV tubing via Foley bag tubing

IV tubing connected to chest tube via Foley bag tube (left photo is a closeup view with arrow designating IV fluid flow)

Read other Tricks of the Trade posts.

Free Comprehensive Curriculum: Climate Change and Emergency Medicine

During the COVID-19 pandemic, a few of us interested in climate change science met through the Society for Academic Emergency Medicine (SAEM), and our group slowly expanded with the virtual world. We discussed the ever-growing number of climate publications and scholarship opportunities available. Some of us did research, education, or policy work, and all of us practiced clinically.

Negative climate-related impacts that we see in the Emergency Department

We discussed how climate-related impacts negatively affected our patients, and brainstormed how we could tackle the problem now. For us in Rhode Island, Pennsylvania, Wisconsin, Colorado, and California, the climate crisis was pathology and interrupted treatment regimens, but also an opportunity to transform current care systems. At all of our hospitals, patients were brought in by ambulance with empty inhalers and non-functioning medical devices after losing electrical power. Monitors beeped from abnormal vital signs of patients impacted by extreme heat, inland and coastal flooding, or wildfires. We recognized the dangers related to place of residence and structural drivers that exacerbated existing health disparities. We agreed that open access education was the next step to action and striving for justice across our nation together.

How to start your climate change learning and advocacy journey?

More and more colleagues asked us where they could begin their own climate and emergency medicine journeys. We used our varied local and global experiences to curate content that could be used for journal clubs, medical simulation, quality improvement projects, grant applications, and other educational tracks or electives. Our goal was to provide a starting place for individuals who may not have dedicated faculty at their institutions.

Get caught up: Comprehensive 10-module curriculum

Climate change and emergency medicine 10-module curriclum

We are proud to announce a comprehensive 10-module curriculum on Climate Change and Emergency Medicine (EM) worth 56 hours of ALiEMU learning credits. Each module encompasses a broad range of reading materials and is followed by a brief quiz on ALiEMU. All of this is available for free. Get learning now.

Be a climate changemaker

We hope the material reminds all of us of what actions are needed yet: authentic partnerships, clear communication of the robust evidence that we know, inclusivity, and leadership. Like emergency medicine, climate change and health work is truly life-long learning. Yet, knowledge is only as good as its use. We look forward to years of innovative solutions that move beyond dialogue and meaningfully address some of the greatest barriers to well-being for our patients and global community.

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By |2022-12-13T14:27:20-08:00Dec 14, 2022|ALiEMU, Environmental, Medical Education|

SAEM Clinical Image Series: Red, White, & Blue


A 29-year-old female presented to the emergency department for a rash on her right calf. 5 days prior, at her home in Alabama, the patient developed pain and swelling of her right calf following a spider bite while putting on her pants. The patient felt a “burning pain” and found a spider which she then killed. She went to a hospital and received cephalexin, trimethoprim/sulfamethoxazole, and oxycodone. Despite taking these medications she continued having aching pain rated 10/10 in her right calf along with generalized pruritus. The patient stated that the bite evolved from an initial generalized redness into a blue/black lesion with blistering and extensive redness along her leg and torso. She denied fever, chills, lightheadedness, abdominal pain, nausea, vomiting, and hematuria.


SAEM Clinical Image Series: Tick Bite

Rocky Mountain Spotted Fever tick bite hand rash

A 14 year old girl presenting from Mexicali with altered mental status. Her mother reports a rash about a week ago following a tick bite. She had been going to school until 4 days ago when she became very fatigued with associated vomiting, diarrhea, tactile fevers, and headache. She subsequently collapsed at home today and was difficult to arouse which prompted EMS activation. Her mother denies any prior complaint of neck stiffness, shortness of breath, cough, hematemesis, or hematochezia.


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