Tamingthesru

Grand Rounds Jeffery Hill, MD M.Ed Grand Rounds Jeffery Hill, MD M.Ed

Grand Rounds Recap - 4/29/15

Morbidity and Mortality Conference with Dr. Stull

1. Pericardiocentesis tips and tricks

  • Your needle should be at a 45 degree angle when entering the chest at the xyphoid process, aim to the L shoulder/scapula
  • Use a spinal needle and keep the stylet in while entering the skin in order to prevent needle clogging
  • Keep head of bed at 30 degrees to encourage the fluid to drain inferiorly
  • Can attach an EKG lead to the needle by an alligator clip. You will get an ST elevation in that lead if you hit the myocardium
  • Can use an A.line kit to place a catheter into the pericardium for continuous drainage
  • US probe position: subxyphoid
  • How to Video on TamingtheSRU - http://www.tamingthesru.com/blog/acmc/pericardiocentesis
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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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Air Care Orientation Curriculum, Prehospital Medicine Jeffery Hill, MD M.Ed Air Care Orientation Curriculum, Prehospital Medicine Jeffery Hill, MD M.Ed

Flights - A Pain in My Heart

You are the Pod doc overnight on a particularly quiet Sunday night.  You have been looking for an excuse to leave the pod and do anything other than treat abdominal pain for the past several hours when the tones drop.  You thank whatever celestial being you believe in and grab the blood and run out of the department full of glee.  In route to the helipad you are told it is a Code STEMI.  At this point, even that seems more interesting than sitting in C Pod.

You buckle into the helicopter and take a quick flight to the outside hospital.  You grab a set of gloves and unload the cot carefully and walk inside.

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