This week we get acquainted with airways. Airway almost always comes before breathing and circulation in the life support algorithm, for good reason. Being able to assess and manage an airway is a core critical skill for an emergency doctor.
The first excellent post to read today relates to assessing an airway:
This week we covered the important and life saving treatment of anaphylaxis. There are no tricks, the answer is adrenaline. Know your doses, know your adrenaline dilutions and know what to do next. Important readings for this week are below.
The paralysis tick in Australia can transmit a carbohydrate (alpha-Gal) that cause humans to create ‘anti-Gal’ antibodies. Once IgE mediated antibodies develop, resultant meat consumption containing alpha-Gal can cause anaphylaxis. This mammalian meat allergy was only recognised in 2007! Poultry and fish are safe though, yet another reason to live in the Torres Straits. Just in case the trivia couldn’t get more obscure, there is alpha-Gal in cetuximab, gelofusin, haemaccel and porcine heart valves and there is one reported case of anaphylaxis post a porcine heart valve transplant.
Establishing vascular access urgently in the emergency department can be critical and life saving. This week we discuss and practice the variety of ways you may establish access in urgent and non-urgent situations (including peripheral intravenous cannulas, rapid infusion catheters, intraosseous and central venous catheters/PICC lines).
Can’t get IV access in a hurry?
Intraosseous (IO) access: It is essential to become familiar with the life-saving intraosseous needle. There are drill and manual IOs and the following website has a host of useful videos and documents on becoming familiar with anatomy and insertion techniques and how to care for an IO. There is a free EZ-IO app that also guides you through insertion.
RIC lines: Rapid Infusion Catheters are great if you need….rapid infusion. Remember Poiseuilles law. If you need to give large volumes of fluid or blood, you want a large bore and short line. Central lines are great for infusions of multiple agents, but are not a resuscitative line.
Put a peripheral IV cannula in with a size you are confident you can achieve. A 20G peripheral IVC is better than a haematoma and unsuccessful 16G attempt.
A 20G peripheral IVC or larger can be converted to a RIC.
Learn ultrasound guided access as early as possible and practice regularly.
Do not be afraid of the IO. It will save lives and is often easier to insert than a cannula.
Pressure bags can free a staff member in a resuscitation scenario.
The Island Docs ED Teaching program occurs twice a week at flexible times to suit our ED resident, medical students and the SMO. Teaching sessions are a two way learning process for our juniors and seniors.
As we will not even begin to cover the essentials of emergency medicine in these 30-45min slots, the sessions will mostly be designed to be practical with some theory thrown in. As a background to our weekly sessions, we strongly recommend you complete the LearnEM EDGE course as a theoretical background. The online course is free and can be completed in the ED when you have ‘downtime’ in the quiet periods. It is designed to run over 10 weeks and requires at maximum 5 hours/week of input.
