Emergency Procedure

Aka: Emergency Procedure, Emergency Department Procedure, Emergency Procedure Skills, High Acuity Low Opportunity Procedure, HALO Procedure, HALO Event

1. See Also
   1. ABC Management
   2. Trauma Evaluation
   3. Bedside Ultrasound (Point of Care Ultrasound)
2. Definitions
   1. High Acuity Low Opportunity Procedure (HALO Procedure, HALO Event)
      1. Risky, rare procedures (e.g. Cricothyrotomy) in life threatening events
3. Approach
   1. Maintaining procedural competence and proficiency
      1. We lose skills over time in procedures we perform infrequently
      2. Skills start waning as early as 2 months after the last time performed
      3. Practice procedural skills frequently (e.g. visualization, procedure courses)
      4. Schedule procedure self-study and practice frequently (e.g. one procedure per month for 30 minutes)
      5. Watch online procedure videos
      6. Improvise practice tools (e.g. toilet paper roll for Cricothyrotomy practice)
      7. Coordinate group procedure practice
   2. Use visualization to learn or prepare for a procedure
      1. Picture the scenario, the environment and the patient
      2. Visualize the step-by-step approach to performing the procedure
      3. Move your hands as if performing the procedure, and vocalize orders
      4. Orman, Herbert and Cloyd in Herbert (2017) EM:Rap 17(4):14
4. Procedure: Airway
   1. Airway Adjuncts
      1. Nasopharyngeal Airway
      2. Oropharyngeal Airway
      3. Laryngeal Mask Airway (LMA) and other Extraglottic Devices
      4. Elastic Bougie
   2. Definitive Airway
      1. Advanced Airway
      2. Rapid Sequence Intubation
      3. Endotracheal Intubation
      4. Endotracheal Tube
      5. Awake Nasotracheal Intubation
   3. Failed Airway
      1. Cricothyrotomy
      2. Needle Cricothyrotomy
      3. Tracheostomy
5. Procedure: Breathing
   1. Ventilation
      1. Positive Pressure Ventilation (e.g. Bag Valve Mask)
      2. Non-Invasive Positive Pressure Ventilation (NIPPV, CPAP, BiPap)
      3. Mechanical Ventilation
      4. Ventilator Troubleshooting
   2. Pneumothorax
      1. Needle Thoracentesis
      2. Small Caliber Chest Tube
      3. Chest Tube
   3. Monitoring
      1. Lung Ultrasound
      2. ABG Interpretation
6. Procedure: Circulation
   1. Access: Child and Adult
      1. Intravenous Access
      2. Intraosseous Access
      3. Peripheral IV Access
      4. Central IV Access
      5. Ultrasound Guided Vascular Access
   2. Access: Newborns
      1. Umbilical Artery Catheter
      2. Umbilical Vein Catheter
   3. Monitoring
      1. Arterial Cannulation
      2. Central Venous Pressure
      3. Emergency Echocardiography
   4. Pericardium
      1. Pericardiocentesis
   5. Arrhythmia
      1. Synchronized Cardioversion and Defibrillation
      2. Emergency Transvenous Pacing
   6. Resuscitation
      1. ABC Management
      2. Trauma Primary Survey
      3. Trauma Secondary Survey
   7. Trauma
      1. Emergency Thoracotomy
7. Procedure: Head and Neck
   1. Eye
      1. Corneal Foreign Body
      2. Lateral Canthotomy for Retrobulbar Hematoma
      3. Intraocular Pressure
      4. Eye Ultrasound
   2. Nose
      1. Nasolaryngoscopy
      2. Anterior Nasal Hemorrhage Management
      3. Posterior Nasal Hemorrhage Management
   3. Throat
      1. Control of Hemorrhage after Tonsillectomy
8. Procedure: Abdomen
   1. Gastrointestinal Tract
      1. Nasogastric Tube
      2. Esophageal Balloon Tamponade
   2. Trauma
      1. FAST Exam
      2. Diagnostic Peritoneal Lavage (rare use in U.S.)
   3. Bladder
      1. Urethral Catheterization
      2. Suprapubic Catheter
   4. Obstetrics
      1. Perimortem Cesarean Section
   5. Ultrasound
      1. Abdominal Aorta Ultrasound
      2. Obstetric Ultrasound
      3. RUQ Ultrasound
9. Procedure: Musculoskeletal
   1. Trauma
      1. Fracture Splinting and Fracture Casting
      2. Intracompartmental Pressure Monitor
   2. Injection
      1. Joint Injection and Soft Tissue Injections
   3. Dislocations
      1. Shoulder Relocation Maneuvers
   4. Ultrasound
      1. See Bedside Ultrasound
10. Procedure: Neurologic
    1. Diagnostics
       1. Lumbar Puncture
       2. Epidural Blood Patch
    2. Trauma
       1. Skull Trephination (Skull Burr Hole)
    3. Headache
       1. Greater Occipital Nerve Block
       2. Transnasal Sphenopalatine Ganglion Block
    4. Anesthesia
       1. Regional Anesthesia
11. Procedure: Dental
    1. See Dental Emergency
    2. Infection
       1. Dental Incision and Drainage
    3. Trauma
       1. Dental Splint
    4. Anesthesia
       1. Inferior Alveolar Block
       2. Periapical Block
12. Procedure: Skin
    1. Trauma
       1. Tick Removal
       2. Fingertip Amputation Repair
       3. Laceration Repair
       4. Fishhook Removal
    2. Infection
       1. Incision and Drainage
    3. Nails
       1. Toenail Removal
    4. Diagnostics
       1. Skin Biopsy