Lumbar Puncture (LP)

Foam Needs Soap Summary Traumatic tap 1 WBC:750 RBC (Roberts and Hedges)   Tests to order: Cell Count Chemistries (Glucose, Protein) Culture/Gram Stain Latex Agglutination (If gram stain negative with suspicion) Cytology-if suspicion of tumor Fungal/AFB/Crypto/VDRL if immunocompromised If you suspect crypto, get opening pressures and closing pressures   A measurement of opening pressure should […]

Thoracentesis

To find the level, use UTS or put stethoscope on the back and tap the sternum with your fingers. What to Send Red tube (LDH, protein, glucose, amylase, triglycerides, and perhaps albumin) Lavender (cell count) ABG syringe for pH CX bottles Two extra tubes Extra red to hold Bag for cytology (or green top) Also […]

Cervical Injection for Headache

http://journals.lww.com/em-news/Pages/videogallery.aspx?videoId=4&autoPlay=true http://journals.lww.com/em-news/blog/M2E/pages/post.aspx?PostID=5 http://journals.lww.com/em-news/Fulltext/2014/11000/Emergentology__A_Needle_in_the_Neck.4.aspx

Burr Holes and Skull Trephination

UC Davis Cheat Sheet Acad Emerg Med 2011;18:78   Emergency department skull trephination for epidural hematoma in patients who are awake but deteriorate rapidly. (J Emerg Med. 2010 Sep;39(3):377-83.) Authors Smith SW, et al. Show all Journal   doi: 10.1016/j.jemermed.2009.04.062. Epub 2009 Jun 17. Affiliation Comment in      J Emerg Med. 2012 Dec;43(6):e489-90.  Abstract  BACKGROUND: Blunt head […]

Blakemore Placement

Blakemore Tube My BP manometer with the adapter from the salem sump test for leaks evacuate air and put in plugs HOB 45 pass it to at least 50 cm numbers on tube should face the right lateral portion of the esophagus on the Bard tube get xray 250-300 cc air in the gastric balloon […]

Pulmonary Artery Catheter (PAC, Swan)

  RudolfI am fan of using of PACs long time ago. I am just try to utilize the cardiac cycle to move it. It looks like a boat floating through the heart. First; i have to think if i really need it and it will affect the patient’s outcome? Are there any alternatives? Second; I […]

Tracheostomy and Trach Emergencies

Head-of-Bed Signs and UK Trach Safety Project http://tracheostomy.org.uk//Templates/Algorithms.html When to Trach Consider when > than 14 days of intubation are planned. Risks include: Tracheoinnominate Artery Fistula (TIA)-causes severe airway bleeding which can be fatal.  Consider hyperinflating the cuff to tamponade bleeding as temporizing measure.  In differential of any bleeding >48 hours after placement. Tracheoesophageal Fistula […]

Pericardiocentesis

Pericardiocentesis 16-18G sheath for initial entry inject agitated saline to confirm 5-7 fr introducer or pigtail J Cardiovasc Ultrasound 1988;7:193 for description of procedure   From Bret Nelson: In this study, a para-apical approach was deteremined to be the optimal site for paracentesis in 2/3 cases: Tsang TS, et al.: Consecutive 1127 therapeutic echocardiographically guided […]

Central Line Placement

Central Venous Catheters and Central Venous Access Central Lines IJ Lines Go straight through medial portion of lateral head of SCM muscle.  (J. Cardio Vasc Anes 8:6) Femorals Higher Infection Rate, Higher Thrombosis Rate than subclavian (French, Prospective Trial JAMA 286:6, 2001 JB   ) Study of cath related infection shows Subclav<IJ<Femoral (Intensive Care Medicine Volume […]

Bronchoscopy

Bronchoscopy simulator online http://www.bronchoscopy.org/ for training and maybe even better http://www.thoracic-anesthesia.com/?page_id=2&langswitch_lang=en   need 2mm larger ET tube than diameter of scope, so 8mm tube to use adult size bronchoscope Anaesthesia 2012, 67, 1042–1056   Procedure from Practical Bronchoscopy Some bronchoscopists prefer to face the sitting or lying patient whilst others stand behind the head of […]