Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.

Common pitfalls in ER Procedure

  • Loggen Sie sich ein, um Kommentare anzuzeigen.

Common pitfalls in ER Procedure

  1. 2. <ul><li>You should understand well about… </li></ul><ul><li>Indication </li></ul><ul><li>Contraindication </li></ul><ul><li>Step & techniques </li></ul><ul><li>After care </li></ul><ul><li>Complication : to be aware of </li></ul><ul><li>Options !! If the procedure FAIL ! </li></ul>
  2. 3. <ul><li>Preparation </li></ul><ul><li>Procedure </li></ul><ul><ul><li>Step </li></ul></ul><ul><ul><li>Skill </li></ul></ul><ul><ul><li>Patient </li></ul></ul><ul><li>After finish procedure </li></ul><ul><ul><li>Fail to check & Secure patient . </li></ul></ul>Other factors Rush/stress step
  3. 6. “ Patients do not die from a &quot;failure to intubate.&quot; 'They die either from failure to stop trying to intubate or from undiagnosed esophageal intubation.” Scott, DB Endotracheal intubation: friend or foe Br Med J (Clin Res Ed). 1986 Jan 18;292(6514):157-8.
  4. 19. <ul><li>Indication : </li></ul><ul><ul><li>Inability to maintain airway with less invasive techniques . </li></ul></ul><ul><ul><li>mostly : in case difficult airway , try ETT first </li></ul></ul><ul><ul><li> with preparation for surgical airway by side. </li></ul></ul><ul><li>Contraindication : </li></ul><ul><ul><li>Airway can be managed by less invasive method. </li></ul></ul><ul><ul><li>Others : </li></ul></ul><ul><ul><ul><li>Partial / complete transection of airway  preferred tracheostomy </li></ul></ul></ul><ul><ul><ul><li>Not suitable in case with significant injury of Cricoid. </li></ul></ul></ul><ul><ul><ul><li>Relative Contraindication : </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Known case of laryngeal pathology (tumor , fracture) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li> prepare to extend to High tracheostomy. </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Special considerations : </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Children : < 8-10 yrs. : Needle cricothyroidotomy only. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Bad positioning : not extend neck. </li></ul></ul></ul></ul></ul>
  5. 20. <ul><li>Techniques : </li></ul><ul><li>Traditional surgical cricothyroidotomy </li></ul><ul><li>Alternative surgical cricothyroidotomy </li></ul><ul><li>Needle cricothyroidotomy </li></ul>
  6. 22. <ul><li>Identify landmark </li></ul><ul><li>Incision : transverse </li></ul><ul><li>not more than 2-3 cm.  Anterior Jugular v. </li></ul><ul><li>Longitudinal only when : </li></ul><ul><li>neck swelling , suspected High Tracheostomy need. </li></ul>
  7. 23. Not deeper than 1.5-2cm.
  8. 30. <ul><li>Internal jugular vein </li></ul><ul><li>Subclavian vein </li></ul><ul><li>Peripherally Inserted Central Catheter : PICC </li></ul><ul><li>Femoral vein </li></ul><ul><li>Peripheral venous cut down </li></ul>
  9. 31. <ul><li>Seldinger </li></ul><ul><li>Catheter over the needle </li></ul>
  10. 34. Rt. IJ 15 Rt. SC 18 Lt. IJ 18 Lt. SC 20
  11. 35. Scalenus anterior
  12. 37. Action tips 1.Prep skin For IJ , prep extend to SC 2. Prep cathetor Flush with Saline 3. Locate vein with finder needle IJ ~ 3 cm. 4. Remove finder needle Cap lock !! 5. Insert introducer needle Traction skin for fix landmark 6. Remove syringe : air embolism Don’t remove hand at all. 7.Insert guidewire Guide dislodge inside pt. or other damage with force. 8. Stop guidewire at 10 cm + skin mark Or when you see ectopy ! Heard arrhythmia. 9. Never let go of the guidewire. 10. Verify tip In SVC not in RA , above azygous v. an d carina. With tip parallel to vessel wall.
  13. 39. Humerus Distal tibia : malleolus
  14. 41. Cook Jamshidi Illinois Bone injection gun EZ IO
  15. 42. Needle decompression for tension pneumothorax And Go-on ICD Landmark : = 2 nd ICS mid clavicular line
  16. 43. <ul><li>Pleural space must be identified. </li></ul><ul><li>Obese patient : Semiupright , beware of diaphragm perforation. </li></ul><ul><li>ICD with Trocar can cause significant injury </li></ul><ul><li>not measurement the chest tube </li></ul><ul><li> last lumen is too closed to skin.  leakage & subcut.emphysema. </li></ul>
  17. 44. <ul><li>You should understand well about… </li></ul><ul><li>Indication </li></ul><ul><li>Contraindication </li></ul><ul><li>Step & techniques </li></ul><ul><li>After care </li></ul><ul><li>Complication : to be aware of </li></ul><ul><li>Options !! If the procedure FAIL ! </li></ul>
  18. 45. Question ?

×