For patients that require prolonged mechanical ventilation, a tracheostomy can be placed either in the operating room as an open surgery, or more preferably at the bedside with a minimally invasive procedure in the intensive care unit by a percutaneous dilational technique under bronchoscopic guidance. This is a step-by-step tutorial for patient selection and procedure techniques.
Part of performing a bedside percutaneous tracheostomy is the procedural documentation. Given that this is a surgical procedure, the documentation should be more thorough than you may be accustomed to doing for an arterial line or central line. Here is a sample procedure note that can be adapted to your local practice.
The Targeted temperature management Trial compared outcomes for therapeutic hypothermia at 33°C versus 36°C for cardiac arrest patients with persistent coma. It may very well be practice changing. Or maybe not. Before we can figure out what “truth” this research study may have uncovered, we will look at the development of therapeutic hypothermia and what the literature has already told us.
The pain of pressure or bumping an swollen inflamed olecranon bursitis is often quite severe. A foam elbow pad can prevent direct impact and avoid causing additional pain. This how-to tutorial will show you how to make one from materials around your department.
Over-wedging of a pulmonary artery catheter can lead to pulmonary artery rupture. This can be caused by an eccentric wedge, which traps the catheter tip against the vessel wall causing fluid to build up increasing the pressure in the trapped cavity.
Transient vagal stimulation from the removal of the CVC and carotid massage from holding pressure to achieve hemostasis can lead to excessive vagal tone which caused blockage of the AV node leading to transient asystole cardiac arrest.
The placement and maintenance of central venous catheters (CVC), have received a great deal attention with the goal of minimizing iatrogenic injury to the patient and reduction in the occurrence of catheter related infections. Once the need for the catheter is done, careful attention
Alteplase (tPA) is used infrequently and often only in emergent situations. Nurses and physicians unfamiliar with preparing the medication may need to high pressure situations. This tutorial includes step-by-step instructions for preparing and mixing tPA.
Nasotracheal intubation is an essential skill that allows a flexible approach to airway management. The BAAM device can speed and simplify both your blind and fiberoptic nasotracheal intubations. Instructions on proper use including patient selection.
An unconventional approach for treatment for ventricular storm may be an ultrasound-guided block of the stellate ganglion which provides sympathetic stimulation of the heart. This may reduce cardiac irritability and facilitate defibrillation.
Cardiac pacemakers and their malfunctions are often daunting for the emergency physician to diagnose and manage. This is the first part of a series covering this area. Part 1. Pitfalls and pearls of temporary transvenous pacing. Part 2. Procedural instructions for placing a transve
A 45-year-old man with severe coronary heart disease s/p CABG but with an unprotected left main, presented to the emergency department for evaluation and suffered a ventricular fibrillation cardiac arrest. CPR and BVM ventilation was initiated immediately. The patient underwent an