Aims Of The Week
- Explain the indications, contraindications and how to commence NIV
- Discuss the investigation and management of the unconscious patient
- Initiate the management of diabetic emergencies
- Implement the WHO analgesic ladder
- Apply the ALS guidelines and list the reversible factors of cardiorespiratory arrest
- Describe the concepts of emergency airway care and rapid sequence induction (RSI)
- Recognise the signs and symptoms of AAA
- Obtain appropriate IV access and insert IO access
- Discuss Anaphylaxis and its management
- Describe the procedure of central line insertion
There a few very important conditions to be aware of that may present with patients in peri-arrest and require prompt action. These include:
Have a browse at this invaluable summary from Life in the Fast Lane & a list of their pearls and pitfalls. There is also a useful SIM teaching case from EM3. Also, ensure you are familiar with the ALS Anaphylaxis Algorithm.
Patients presenting in Diabetic Ketoacidosis or Hyperosmolar Hyperglycaemic State are some of our sickest patients. Have a look at this guide to their management. At the other end of the spectrum, hypoglycaemia is another common reason for attendance, this resource should help you differentate the severity and how to manage it.
When should you consider non-invasive ventilation? How much do you know about NIV including pressure settings & how it works? Try this quiz from Life in the Fast Lane for more information.
Life Threatening Asthma
Become familiar with the ALS management guidelines & have a read at this overview from LITFL.
Acute pulmonary oedema
This is a useful Evidence Based Medicine overview on treatment from Life in The Fast Lane & is well worth a look.
Major Upper GI Haemorrhage
Have a look at this St. Emlyn’s blog all about GI haemorrhage, which includes a podcast if you find that easier.
This is a guide as to when transcutaneous pacing is required & how to perform it.
Obviously, a cardiac arrest is the most time critical event. Revise the ALS Algorithm and become familiar with all of the reversible causes. This LITFL blog provides an overview on patient management after ROSC.
The Unconscious Patient
Often patients presenting to resus are unconscious so getting a history isn’t possible. Have a look at this guide to assessing and managing the unconscious patient as well as trying to diagnose the cause.
Pain of one form or another is one of the most common reasons for ED attendance, this guide gives one approach and the equivalencies of many frequently used analgesics.
Do you know how quickly IV fluids can be delivered through that IV line you’ve just inserted? Is it big enough? Here’s a summary of peripheral IV cannula flow rates. If you are having difficulty obtaining venous access & are ultrasound trained then consider using ultrasound guidance.
You are struggling to obtain peripheral IV access. Do you know about all of your other options? Have a browse at this intraosseous access guide.
Even better than a guide is visualising the process, therefore this video of a conscious doctor having an IO inserted may be helpful (and shows commitment to the cause). Another method of obtaining more definitive access is via a central line. Become familiar with internal jugular venous access through the second video below.
This ultrasound tutorial by 5 minute sono demonstrates central venous access.
Sometimes, patients arrive in our resuscitation room that require urgent airway protection due to a reduced conscious level or require intubation due to aggressive behaviour or the need for neuroprotection. They are usually unfasted with a higher risk of aspiration than elective pre-operative patients. How do we lower the risk & is cricoid pressure all it has cracked up to be? Have a look at this RSI summary from Life in the Fast Lane, RSI drug information & our overview of the process. This is an example of a local ED RSI Checklist.
As a final thought, always remember that working in the resuscitation room is all about teamwork. There is no ‘I’ in team.
TEST YOUR resus KNOWLEDGE WITH OUR QUICK QUIZZES
All mapped to the ACCS & Emergency Medicine HST curriculum!