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You've Been Blocked!
Procedural Education Jeffery Hill, MD M.Ed Procedural Education Jeffery Hill, MD M.Ed

You've Been Blocked!

Case 1

CC:  Laceration to Upper Lip

HPI:  23 year old male presents to the ED with laceration to his upper lip.  Patient states he was “Minding his own business” when all of the sudden the ground came up and hit him in the face.   His friend alcohol might have been there.  Patient states he now has a cut on his lip and a bruise on his pride.

Physical Exam:  Physical exam demonstrates a 2 centimeter full thickness laceration of the left upper lip that crosses the vermillion border.

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Favorite Positions!
IC Cordes, Procedural Education Steven Carleton, MD PhD IC Cordes, Procedural Education Steven Carleton, MD PhD

Favorite Positions!

Multiple casualties are brought to you from a house fire.  There are four victims:

  1. A 5’11” 70 kg woman with a GCS of 8
  2. A 5’9” 140 kg man with circumferential burns of the chest and neck
  3. A 20 month-old with a pedi-GCS of 10
  4. An elderly, 5’6” 65 kg man with no burns, but a history of severe CHF and complaining of chest pain and dyspnea

You determine that they all require intubation for various indications.  You choose RSI as the method for all except the morbidly obese patient, who you intend to intubate awake, with sedation and topical airway anesthesia.

Question:

How would you position each of these patients to optimize your chances of successful intubation on the first attempt?

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Field Amputation
Procedural Education, Prehospital Medicine, Air Care Orientation Curriculum Andrew Latimer, MD Procedural Education, Prehospital Medicine, Air Care Orientation Curriculum Andrew Latimer, MD

Field Amputation

Hey, everybody! Today we are going to talk about field limb amputation.

I know what you are all thinking… No, I’m not crazy. Yes, you’ll probably never do one. No, this is not a common procedure. You just might, however, be in a situation on Air Care where knowing how to correctly perform this procedure can safe a life. 

First, let’s provide a little background on the pre-hospital limb amputation. The procedure itself has gained much more press in the FOAMed world and the emergency medicine and pre-hospital literature since the 2010 earthquake in Haiti during which early physician responders were faced with large numbers of patients trapped under debris and few responders with familiarity or basic working knowledge of the procedure (Lorich et al, 2010). A few of case reports and articles surfaced around this time and the field amp even made an appearance in an episode of the popular television show ‘Greys Anatomy’ in 2011. 

So I was told… 

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