Emergency Procedure

Aka: Emergency Procedure, Emergency Department Procedure, Emergency Procedure Skills

1. See Also
   1. ABC Management
   2. Trauma Evaluation
   3. Bedside Ultrasound (Point of Care Ultrasound)
2. 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)
   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
3. Procedure: Airway
   1. Airway Adjuncts
      1. Nasopharyngeal Airway
      2. Oropharyngeal Airway
   2. Definitive Airway
      1. Advanced Airway
      2. Rapid Sequence Intubation
      3. Endotracheal Intubation
      4. Endotracheal Tube
      5. Awake Nasotracheal Intubation
   3. Failed Airway
      1. Needle Cricothyrotomy
      2. Cricothyrotomy
      3. Tracheostomy
4. 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
   2. Pneumothorax
      1. Needle Thoracentesis
      2. Small Caliber Chest Tube
      3. Chest Tube
5. 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
   4. Pericardium
      1. Pericardiocentesis
   5. Arrhythmia
      1. Cardioversion
      2. Emergency Transvenous Pacing
   6. Resuscitation
      1. ABC Management
      2. Trauma Primary Survey
      3. Trauma Secondary Survey
   7. Trauma
      1. Emergency Thoracotomy
6. Procedure: Abdomen
   1. Trauma
      1. FAST Exam
      2. Diagnostic Peritoneal Lavage (rare use in U.S.)
   2. Bladder
      1. Suprapubic Catheter
7. 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
8. 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
9. Procedure: Dental
   1. Infection
      1. Dental Incision and Drainage
   2. Trauma
      1. Dental Splint
   3. Anesthesia
      1. Inferior Alveolar Block
      2. Periapical Block
10. Procedure: Skin
    1. Trauma
       1. Tick Removal
       2. Fingertip Amputation Repair
       3. Laceration Repair
    2. Infection
       1. Incision and Drainage
    3. Nails
       1. Toenail Removal