Month: April 2016

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Tank. Clogged Pipes. Broken Pipes. Pump.

Introduction

• “Tank”
  • Hypovolemic shock
  • Hemorrhagic shock
• “Clogged Pipes”
  • Cardiac tamponade
  • Tension pneumothorax
  • Pulmonary embolism
• “Broken Pipes”
  • Septic Shock
  • Neurogenic Shock
  • Anaphylactic Shock
• “Pump”
  • Cardiogenic Shock

Step 1: Fill the Tank

• Establish an IV
  • IO line alternative in emergent situations

Step 2: Consider Clogs

• Cardiac tamponade
  • Diagnosis: Ultrasound
  • Treatment: Pericardiocentesis
• Tension pneumothorax
  • Diagnosis: Clinical/Xray/Ultrasound
  • Treatment: Needle decompression and tube thoracostomy
• Pulmonary embolism
  • Diagnosis: Clinical/CTA
  • Treatment: Thrombolytics

Step 3: Squeeze the Pipes

• Administer vasopressors
  • Most common: Norepinephrine
  • Alternatives: Epinephrine, Phenylepherine

Step 4: Analyze the Pump

• Get an EKG
  • Ischemia = Aspirin/Heparin/Cath lab
  • Dysrhythmia = Electricity

Additional Reading

• Airway Part 1 – Immediate Actions (EM Clerkship)
• Breathing (EM Clerkship)
• RUSH Exam (EMCrit)

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Hypoxemia fixed by only TWO things: FiO2 and PEEP

Step 1: Add FiO2

• If the patient is breathing…
  • Nasal cannula
  • Non-rebreather mask
• If the patient is NOT breathing…
  • Bag-valve mask

Step 2: Add PEEP

• *Cannot be completed in 60 seconds, but equipment can be requested
• If patient is breathing…
  • BiPAP
• If the patient is NOT breathing…
  • Intubation

Additional Reading

• Ventilator Basics (EM Clerkship)
• Airway Part 1 – Immediate Actions (EM Clerkship)
• Circulation (EM Clerkship)

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“Airway” does not necessarily mean “Intubation”

Introduction

• In emergency medicine we are taught “A-B-Cs”
  • These are actions that can be accomplished in first 60 seconds of patient encounter
    • Intubation takes several minutes to accomplish
    • Intubating a crashing patient might even KILL them!
  • Resuscitate THEN intubate

Step 1: Suction

• Immediately suction if patient is…
  • Altered and vomiting
  • Gurgling

Step 2: Move the Tongue

• Bedside maneuvers
  • Head tilt
  • Chin lift
  • Jaw thrust
• Adjunct equipment
  • Oropharyngeal airway
  • Nasopharyngeal airway

Additional Reading

• Airway Part 2 – BVM Adjuncts (EM Clerkship)
• Airway Part 3 – Rapid Sequence Intubation (EM Clerkship)
• Airway Part 4 – What to Do If Intubation Fails (EM Clerkship)
• Laryngoscope As A Murder Weapon – Hemodynamic Kills (EMCrit)