Procedures

Airway Mastery Series: Got Oxygen? Head of Bed up for Preoxygenation Before Intubation

Intubation has traditionally been performed with patients in the full supine position. Recent data suggests that elevation of the head of the bed may be more effective during preoxygenation before intubation. Check out this summary of a paper from Anesthesia that put this idea to the test!

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Advanced Practice: Bedside Ultrasound for Improving First-Attempt Lumbar Puncture Success on Infants

Anatomic landmarks followed by a "blind" stick is currently the standard practice for performing bedside lumbar punctures, but with increasing use and ease of ultrasound, could we one day see lumbar punctures follow in the footsteps of central line placement?

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Advanced Practice: Bedside Two Point Compression Ultrasound to Rule-In Pulmonary Embolism by Chad Simpkins MD

You evaluate a patient complaining of acute onset of dyspnea with hypotension and hypoxia. You immediately consider the diagnosis of acute massive pulmonary embolism, but despite your best efforts can't get good cardiac windows on bedside ultrasound. Should you administer thrombolytics? Heparin? Send the shocky patient for a CT? Today Dr. Simpkins goes through the steps to perform 2-point compression ultrasound of the lower extremity to evaluate for DVT, an easy and rapid bedside test that may allow for indrect but more rapid diagnosis of acute, massive pulmonary embolism.

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Advanced Procedures: How to Create a Pericardiocentesis Model

Pericardiocentesis is a rarely performed, but potentially life-saving procedure. Commerical models are prohibitively expensive, but students and residents (and critical care fellows) still need to learn the mechanics, ideally with an ultrasound compatibile model. This week's post gives a step by step guide towards making a cheap, easy to fabricate phantom based on this fantastic paper published in the Journal of Emergency Medicne 2012: https://www.ncbi.nlm.nih.gov/pubmed/21925818

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#EMconf: Do Trigger Point Injections Improve Musculoskeletal Pain?

Have you ever attemped a trigger point injection to improve your patient's musculoskeletal pain?  Did it help?  This week for his Critically Appraised Topic, Dr. John Cafaro investigated some of the literature on the effectiveness of trigger point injections for patients suffering from musculoskeletal pain.  

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Advanced Practice - Paracentesis-induced circulatory dysfunction (PICD)

Do you routinely perform large volume (or near large volume) paracentesis in your ED? If so, you need to know about a potentially life-threatening complication of this procedure...

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Baby, It’s Cold Outside: Death by Hypothermia

For some, this topic may be more bread and butter than others. Many of you may work in cold areas where you are likely to see patients with hypothermia on a regular basis, especially in the winter. Whether you work shifts in a mountainous region or are simply catching up on EM topics while studying for boards in your in you flip flops by the beach, here are a few pearls regarding patients who present with hypothermia and their management.

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Airway Mastery Series: Mastering the Bougie

You are intubating a sick patient in the ED via direct laryngoscopy. After opening the airway, sweeping the tongue with your blade, inserting into the vallecula, and lifting at the precisely correct angle your eyes behold....well...not the vocal cords! Maybe the arytenoid cartilages if you're lucky (aka Cormack Lehane 3 or 4 view). But wait, you aren't finished yet! You reach into your back pocket and remove your trusty bougie...

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