Archive for category: Procedures

Performing Procedures Like a Boss, in the ED Without an IV

24 Oct
October 24, 2018

Background: Establishing IV access has become the norm for patients presenting to the ED.  However with increasing patient volumes, difficulty and delays in acquiring IV access, it seems that anything that could expedite care, reduce pain and suffering, and improve patient care would be welcomed in the ED.  There are several tricks I have learned along […]

Pediatric Push Dose Epinephrine: Getting the Epi Dose Right During Pediatric Resuscitation

13 Sep
September 13, 2018

Warning: Limited Published Evidence on this Topic You have just intubated a 4 year old with sepsis from a bad pneumonia. Post intubation BP is 70 systolic, while waiting for the epinephrine (adrenaline) infusion to come up from pharmacy you watch the BP decline into the 60 systolic range and start to use fluids to […]

More on the Easy IJ

04 May
May 4, 2017

Background: IV access is one the most important interventions that must be performed in effectively managing patients in the Emergency Department.  It is part of “Circulation” in the ABCs acronym and is even first in the “IV, O2, Monitor” phrase that we have become accustom to hearing.  Although experienced ED nurses can obtain access quickly and […]

The Easy IJ: Another Option for Difficult IV Access in Stable Patients?

24 Apr
April 24, 2017

Background: We have all taken care of patients in whom IV access is difficult due to a multitude of reasons including repeated prior IV access, advanced vascular disease and shock. This often creates delays in patient care, increases ED length of stay, and uses up ED staff that have other patients to care for. Many […]

Intraosseous (IO) Needle Length in Obese Patients

09 Jan
January 9, 2017

Background: Intraosseous (IO) access can play an important role in the resuscitation of the critically ill patient to help expedite delivery of critical medications (i.e. RSI). Much like with peripheral or central access, obesity can present a challenge to placement of an IO as accurate placement relies on use of landmarks which may not be palpable […]