Resuscitation and emergency procedures

Published on 14/03/2015 by admin

Filed under Emergency Medicine

Last modified 14/03/2015

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Chapter 3 Resuscitation and emergency procedures

This chapter gives a brief overview of major procedures which may be carried out in the emergency department. It is meant to be used as a reminder for a doctor who has already been trained in these techniques, and not as a training manual. The common procedures should be practised under supervision, and the uncommon procedures should be formally taught before they are attempted solo. Some procedures require both training and experience, and some institutions require formal accreditation for operators (e.g. for focused assessment with sonography for trauma (FAST) scanning). Many procedures and their integration into complex, team-based resuscitation are best learnt in a simulator laboratory rather than in an emergency department.

For all procedures, the following steps are essential:

INTRAVENOUS ACCESS TECHNIQUES

There are four basic intravascular access techniques:

Intraosseous infusion—paediatric or adult

This is a rapid technique for reliably obtaining vascular access in sick, small children. It can be used in patients of all ages, but the thicker bones of older children and adults mandate the use of a specially designed drill rather than manual insertion. Blood can usefully be drawn for biochemistry (not haematology) and large volumes of fluid or drug infused. It is highly recommended that this technique be practised on animal bones before it is attempted on a patient.

Intravenous lines—central