Validating the Select Use of ED Thoracotomy

ED thoracotomy  allows for evacuation of pericardial tamponade, direct control of intrathoracic hemorrhage, open cardiac massage, cross-clamping of the descending aorta, and is life-saving inselect patients.  

Bubble Test to Confirm Central Line Placement

One of the more serious complications of central venous catheter (CVC) placement involves arterial puncture and cannullation with a large caliber dialator and catheter.  This occurs in up to 5% of all CVC placement attempts.  

Affirming the Use of Early Narcotics for Acute Abdominal Pain

Acute abdominal pain accounts for 5-10% of all chief complaints to emergency departments.  There has long been debate regarding the role of analgesia in those presenting with acute abdominal pain.  Concerns of masking symptoms and less precise serial abdominal examinations feature prominently amongst those who advocate that aggressive analgesia is detrimental.  The humanistic desire to treat pain and the dearth of evidence implicating analgesia with decreased diagnostic certainty are frequently cited by those in favor of early analgesia.  Furthermore, newer imaging modalities have significantly altered traditional practice dogma as physical examination along with laboratory evidence suggestive of an acute abdomen are now followed by imaging to further clarify if patients are operative or non-operative candidates.

The Cunningham Technique for Reduction of Shoulder Dislocations

Dislocation of the shoulder joint is the most common major joint dislocation¹ and is a presenting complaint that every emergency physician must be familiar with.  The incidence of shoulder dislocations in the US has been estimated at 23.9 per 100,000 person-years² and of these, 95-97% are anterior dislocations.  Often procedural sedation is used to reduce shoulder dislocations which is not without its own risks, ties up nursing staff and increases length of stay in the Emergency Department³.   The Cunningham technique4 for shoulder reduction, described below, offers a method that does not require sedation and inflicts little to no pain on your patients.

Passive Leg Raise & Hemodynamics in the ED

Without adequate tissue delivery of oxygen, early shock states quickly progress to multi-organ dysfunction syndrome (MODS) in critically ill patients.  Early goal directed therapy (EGDT) with aggressive crystalloid resuscitation has been instrumental in halting and reversing a subset of distributive shock states.