Time-critical procedures for emergency situations
•Download as PPT, PDF•
3 likes•1,055 views
This document discusses various time-critical procedures that may need to be performed in emergency situations. It provides guidance on being cognitively and materially prepared to perform these procedures. Specific procedures covered include intraosseous access, fasciotomy for compartment syndrome, lateral canthotomy for orbital compartment syndrome, and escharotomy for severe circumferential burns. Case examples are also provided to demonstrate how to apply these procedures.
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (20)
Similar to Time-critical procedures for emergency situations
Similar to Time-critical procedures for emergency situations (20)
More from Kane Guthrie
More from Kane Guthrie (17)
Recently uploaded
Recently uploaded (20)
Time-critical procedures for emergency situations
- 2. Time Critical Procedures • Often performed in frequently • Life saving • You must be prepared for these • Cognitive hurdle
- 4. Being Ready • This is the sharpest end of what we do • Need to be ready: • Cognitively • Materially
- 5. Metacognition • Cognitively • Invisible simulation • Develop/prepare plans-scenarios in your mind • Knowing what you need to know • Leads = metacompetence
- 6. Human Factors • Manage your catecholamines
- 7. Cognitive Hurdle • Hardest part of doing most of these procedures is making the decision to do it!
- 8. Dominating the Resus Room • Know your environment • Know your equipment • Know your drugs • Know your algorithms
- 9. Getting the Most out of the Team • Be Nice • Be authoritative • Stay patient focused • Ask for help • Use the group • Push the right buttons • Craft your language
- 10. Resus Room Law Cliff Reid. www.Resus.Me.com
- 12. Checklist Help
- 15. Warning
- 16. Case 1 • 44 female • Rigid abdomen • Septic shock • IVDU
- 17. Difficult Vascular Access • Your options: • Ultrasound guided PIVC • CVC • IO
- 18. Intraosseous Access • Needle inserted into bone • Non-collapsible vein • Infuse into systemic circulation • 97% first pass success rate • Insertion in under 30secs
- 19. Intraosseous Access • Equal predictable drug delivery • Equal pharmacological effect • Flow rates 125-250mls/min • Pain comparable to PIVC • Dwell time 24hours
- 21. Case 1 • No luck PIVC • IO - humeral head • Given 2litres CSL • RSI- Ketamine-Roc • Given 2g ceftriaxone • 2/24 later CVC inserted
- 25. Compartment Syndrome • Limb threatening condition • Increased pressure with muscle compartment • Compression of - nerves, muscles & vessels within compartment
- 27. Causes • Fractures - 75% • Crush injury • Snake bite • Excessive exertion/imobilisation • Constrictive -POP, tourniquet • Soft tissue infection/burns
- 28. Pearl • Patients with a coagulopathy are at particular risk of compartment syndrome.
- 29. History & Physical • Pain (especially on passive stretching) • Pallor • Perishingly cold • Pulselessness • Paralysis • Paraesthesia
- 30. Fasciotomy • Surgical procedure where the fascia is cut to relieve tension/pressure resulting in loss of circulation to tissue or muscle.
- 31. Indications • Delta pressure <20mmHG definite • <30mmHg relative • Clinical signs suggesting
- 32. Pearl • Palpable distal pulses & normal CRT does not exclude compartment syndrome!
- 33. Preparing • Best done in theater with orthopod! • May be done in ED • Scalpel & sterile area
- 35. Pearls & Pitfalls • Give analgesia • Keep these patient hydrated • Monitor urine output • Hopefully prevents rhabdomyolysis
- 37. Case 3 • 24 male • Drunk • Baseball bat vs head http://lifeinthefastlane.com/ophthalmology-befuddler-033-2 /
- 38. Case 3 • Unable to detect light • Afferent pupil defect R eye • Reduced extraocular movement • Tonmetry reveals IOP 45mmHg
- 39. The Bulging Eye • Retrobulbar haemorrhage result in orbital compartment syndrome.
- 40. Acute Orbital Compartment Syndrome • Cause - trauma, operatively • Haemorrhage into orbital space • Transmits pressure onto optic nerve • Results- swelling, visual loss.
- 41. History • Symptoms: • pain • decreased vision • inability to ope eyelids • proptosis
- 42. Physical Exam • Decreased visual acuity • Swelling • Limited extraocular movements • Tonometry - raised IOP • Funduscopy - papilloedema
- 43. Treatment Options • Conservative • Topical timolol • Acetazolamide • Mannitol • Lateral Canthotomy
- 44. Lateral Canthotomy • Sight saving procedure
- 45. Indications
- 47. The Procedure
- 49. Case 4 • 29 male • Meth lab explosion • Severe Burns • Struggling on the vent! http://lifeinthefastlane.com/trauma-tribulation-005/
- 50. Escharotomy
- 51. Indications • Circumferential burns to chest - impair ventilation • Constrictive circumferential neck burns impair airway • Circumferential burns extremities
- 52. Preparing • Best done in theater • Need scalpel, diathermy, artery ties, topical haemostatics • Good anaesthesia - Ketamine
- 55. Escharotomy Complications • Bleeding • Infection • Damage to underlying structures
- 56. Take Home Points • These procedures are uncommon • You need to be cognitively prepared • Know your equipment • Avoid failure to act
- 57. Questions