EM Bound

One task every EM sub-I should know how to do is place an IV. But frequently the ED may be the first time you really place an IV - most patients come to the floor with an IV already in. The video will walk you through placing an IV, with a quick text summary below. Materials: -Fluid Bag -Flush -Cannula and needle -IV Start Kit (tourniquet, tape, transparent dressing, alcohol, gauze, small extension) -Tubing Technique: Before any procedure: Wash your hands and use proper protective equipment (here: gloves) Also remember you can change the position of the patient and the lighting in the room. These can make an enormous difference in your success rate (not to mention sparing contorting yourself into uncomfortable positions). 1. Set up and flush all the lines. This means spike the bag, clamp it off, and put the flush syringe on the small extender 2. Find the vein. Place the tourniquet on to help. 3. Prep the patient. Use the alcohol to clean the site, ...

As a sub-I you may be called on to consult a service – that is, after all, one of the two end pathways of anyone who walks into the ED (ignoring AMA). Calling a consult from the ED is just as much a skill as intubation or IV placement. It can take a whole residency to develop, but having the basics will move you away from shadowing med student towards functional sub-I.  Below is your step-by-step walkthrough of the process at the sub-I level. 1. Know why you’re consulting. Hopefully this is your patient, but if things get busy you might be asked to help with other patients (more so if the consult should be straightforward). Know the case, and specifically what you're calling for. Do you want the team to take them to the OR urgently, do you want them to come to the ED and write a note? This is something your senior residents and attending will help you identify. Phrase it as a question: "Does this patient need an emergency endoscopy? If not, we are wondering wh...

The only thing you'll see more than chest x-rays in the ED will be EKGs. Even if you've never seen a specific pathology before you need to be able to read it. In other words, you need a system! In the end, whatever works for you is important, but this is one I learned: Technical ABCDE. Technical This is all the non-anatomy parts of the film. ID: name, type of image, position of image (AP vs PA), correct date and MRN tend to be skipped, though some attendings will like to hear them. You should still verify these regardless. Image: Inspiration (can you count 8-10 posterior ribs), penetration (usually less of an issue with digitally captured x-rays), and rotation (look for symmetric angle of clavicles with sternum in non-rotated film). Patient: Any tubes, wires, catheters you see - especially note where central lines, PICC lines, and ET tubes end. A Airway: Is the trachea midline or deviated? B Bones: Look for overt fractures, dislocations, and lytic lesions ...