1. ED orientationCrash Course in Emergency MedicineFor junior ED docsPreparationABCsMonday, 27 May 13

2. Not comprehensiveJust the things you really need to know / will scare the crapout of youMonday, 27 May 13

3. Ask a nurseMonday, 27 May 13

4. If you are thinking Should I discuss this with asenior? ...Monday, 27 May 13

5. Monday, 27 May 13

6. We are very lucky to get ambo call about mostserious casesMonday, 27 May 13

7. The 5 Ps of PreparationPeoplePlaceProtectionPlantPlanMonday, 27 May 13

8. PeopleGet extra hands first rate limiting stepGet some extra help in if in doubt ask the nursesED consultantAnaesthetist/regSurgical registrarXRayCTLabExtra nursesAssign roles eg team leader, airway doc/nurse, examining doc,lines + procedures doc/nurseMonday, 27 May 13

9. Monday, 27 May 13

10. Monday, 27 May 13

11. PlaceCreate a space for themMove people out of resusMove people out of EDMonday, 27 May 13

12. Personal Protective EquipmentXRay gownGogglesMasksApron/gownGlovesMonday, 27 May 13

13. Plant = equipment and drugsPrepare ultrasound machine, blood, drugs eganalgesics, airway equipment etc asrequired based on the information you haveMonday, 27 May 13

14. PlanTalk through your plan based on what youknow with the teamAs you think out loud others can chip in withthings you may not have thought ofGets everyone on the same pageBut remember the plan may change rapidlyMonday, 27 May 13

15. ABCDEfGCan be applied to 95% of what we see in EDUse it for your approach and yourdocumentationMonday, 27 May 13

16. A + ?Monday, 27 May 13

17. Airway + c-spineSpinal precautions initially for any moderate -major trauma.Stabilise c-spine with collarGrip head and shoulders when movingControlled slide on sliding board OKMonday, 27 May 13

18. 2 best airway tools?Monday, 27 May 13

19. Monday, 27 May 13

20. Basic airway maneuversWhat are they?Monday, 27 May 13

21. Jaw thrust - mainly we do this oneChin liftHead tiltMonday, 27 May 13

22. Basic airway adjunctsWhat are they?What size do you use?Monday, 27 May 13

23. OPA = Guedelo Size from corner of mouth to angle of jawo Insert upside down in adult, then rotateo Insert right way up in kidso If the patient tolerates an OPA thats a fairly good indicationthey arent protecting their airway and probably need to beintubatedo Image http://www.aic.cuhk.edu.hk/web8/0190_Guedel_airway_sizing.jpgMonday, 27 May 13

24. NPAo From nostril to tragusLMAo Weight written on packet.o 5: adult maleo 4: adult femaleMonday, 27 May 13

25. Bag-Valve-Masko Essential skillo Mask fits over bridge ofnose and below lower lipbut not under chino Little finger behind ramusof mandible to lift jawforwardo Use a two hand grip onface and mask if needed get someone else tosqueeze the bag ifneeded Image: https://www.proceduresconsult.jp/UploadedImages/pcj_0010_00000026_100000_large.jpgMonday, 27 May 13

26. Anaesthetic drugsOnly with a Senior Medical Officer at thebedside.(But our system allows heroic doses ofnarcotics and benzodiazepines which areprobably more dangerous. Just dont sendsomeone to Xray with a big dose of opioidson board)Monday, 27 May 13

27. ETTSo for you guys flying solo, an ETT is only fordead people.LMA very acceptable (for anyone with no gagreflexIf you are intubating we have a videolaryngoscopeMonday, 27 May 13

28. StridorBad stridor - what are you going to do?Monday, 27 May 13

29. Stridor5mg nebulised adrenaline / epinephrine = 5mlampules of 1:1,000 (unless < 10kg -> 0.5ml/kg of 1:1,000)Steroideg dexamethasone 0.6mg/kg (max 12mg)PO, IM, IVMonday, 27 May 13

30. AnaphylaxisBad anaphylaxisWhat are you going to do?Monday, 27 May 13

31. AnaphylaxisMild cases may respond to just nebulised adrenaline, IV fluids,steroidsBUT if in doubt: 0.5mg IM adrenaline + the above+ steroids eg dexamethasone as for stridor+/- IV adrenaline eg 5-20mcg q5min eg 1ml of 1:10,000 made up to10ml with normal saline = 10mcg/ml) http://emcrit.org/podcasts/bolus-dose-pressors/+/- AntihistaminesMonday, 27 May 13

32. Cant ventilateWhat are you going to do?Monday, 27 May 13

33. Cant ventilateSurgical cricothyroidotomy or needle cric in kidsSurgical: scalpel - bougie ETThttp://www.emrap.tv/index.php?option=com_content&view=article&id=2274:EMRAPTV94-Cric-BougieNeedle cric: eg 16G iv cannula through cricothyroid membrane. Wall Oxygen@ 1L/min/year of age. 1 second on, 1 second off. We have a home madejet insufflation kit in the bottom draw of each airway trolleyAirway study day twice a year in Whanganui: crics, chest drains etc on deadsheep.EMST or Auckland Airway Course to do same on anaesthetised animalshttp://www.surgeons.org/for-health-professionals/register-courses-events/skills-training-courses/emst/http://www.airwayskills.co.nz/page.php?3Monday, 27 May 13

34. http://www.emrap.tv/index.php?option=com_content&view=article&id=2274:EMRAPTV94-Cric-BougieMonday, 27 May 13

35. http://www.emrap.tv/index.php?option=com_content&view=article&id=2274:EMRAPTV94-Cric-BougieMonday, 27 May 13

36. Big tonguePatient with idiopathic tongue angioedemaWhat are you going to do?Monday, 27 May 13

37. Big tongueNebulised adrenalineUsually ends up on a medium dose adrenalineinfusion eg 12mcg/minuteMonday, 27 May 13

38. BMonday, 27 May 13