arterial line | Improving care in ED

There videos were posted recently to support a wonderful Procedures teaching session run by Dr Lynn Theron…

Cricothyroidotomy – for information on “the difficult airway” also see the RSI fact sheet found here.

Chest decompression and chest drain insertion: video one and video two; for more in depth discussion of pneumothroax see the fact sheet found here.

Limb tourniquet application

Use of stapler

IO insertion: landmarks are from the 10 minute mark…

Pelvic sling application: the demonstrators look like they’re doing an inflight safety video… for more in depth discussion of pelvic fractures, see the Pelvic Trauma fact sheet found here.

Donway femoral splint application: you most likely have no idea how to work this contraption… but you should! This video stars either Smurfs or The Blue Man Group for some reason… the femoral fracture fact sheet can be found here.

FAST scan: clearly, you have to complete the course to be a competent FAST scanner – but if you’re constantly looking over your consultant’s shoulder wondering what they’re looking at, maybe watching this video will make you appear more intelligent!

Arterial line insertion: useful from the 2 minute mark…

Pericardiocentesis: rarely done, therefore probably rarely well done! For more information on pericardial tamponade, there’s a fact sheet here.

Suprapubic catheter insertion: be sure to use ultrasound as a guidance – we have it in ED for a reason!

ED thoracotomy: everyone has an inner surgeon just yearning to get out!

ED perimortem C-section: hopefully you will never be called upon to perform this, but in case you are…

(by Mike Nicholls)

The scenario

Imagine….

You are in ED when an R40 is received that a young victim of road trauma is enroute. She is hypoxaemic, tachycardic, hypotensive, and combative, and has facial, chest and limb injuries including a mangled upper limb and femoral shaft fracture.

ETA is 5 minutes.

Oh dear. What to do…

Try using the highest fidelity simulator available to you (your imagination) to plan what you might do to prepare for the arrival of this very unwell patient.

In particular, which procedures might be needed? (hint, below is a list of procedures, with internet links, which you may wish to be familiar with PRIOR to her arrival…Another good source of info for procedures is the text book by Roberts and Hedges. We have a copy at staff base, but I believe if you are on the training program this book is subsidized, so is essentially FREE to you. Get a copy from Medical Books, just down the road from AED.)

Be positive! Good luck!

Please note, we probably won’t cover all of these procedures on 30 July.

CRICOTHYROTOMY (thanks to Petro)

RAPID RHINO INSERTION

CHEST DRAIN INSERTION (thanks to Mark Gardener)

CHEST DECOMPRESSION AND DRAIN INSERTION – click HERE for many links – LifeInTheFastLane: Own The Chest Tube!

FINGER THORACOSTOMY – Needle versus knife for chest decompression, podcast by Scott Weingart HERE (or click HERE for full show notes and references)

LIMB TOURNIQUET APPLICATION