(by Mike Nicholls)
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
(suggest watching from the 10 minute mark for landmarks)
PELVIC SLING APPLICATION
DONWAY FEMORAL SPLINT APPLICATION
(Somewhat weird Smurfs-in-snow version, takes 3 minutes. In the ED we would advocate removing ski boots prior to application…)
E-FAST ULTRASOUND EXAM
(Some good views demonstrated, although I don’t agree with their comments about not visualising the kidney in the perisplenic view)
ARTERIAL LINE INSERTION
(check this out from 2.10 until 4.40)
CENTRAL LINE INSERTION
(Not really applicable in trauma, but still…Also, I think we would generally leave a catheter in situ)
USE OF A STAPLER – click HERE
SUPRAPUBIC CATHETER INSERTION – click HERE
(We would use ultrasound to aid this procedure (ie ensure that really is a large urine filled cavity))
ED THORACOTOMY – click on this link for a ‘how-to-do-it’ pdf: Emerg Med J-2005-Wise-22-4
PERI-MORTEM C-SECTION – click HERE
Time to OWN THE RESUS and MAKE THINGS HAPPEN!