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Bioskills provides an opportunity to practice a range of procedures–some rare and some common. Below I have provided my favorite videos of these procedures to reinforce the learning from our recent bioskills lab. I have tried to select short (<5 minute) videos that you can review at your leisure. For more in depth reviews follow the links at the bottom of the page.
Enjoy!
~Chris
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Airway
Learn to use the bougie because it can definitely get you out of an airway jam.
Chest Tube
Chest tube placement
Chest tube drains
To understand chest tube drains you just need to know about THREE chambers: the collection chamber, the water seal chamber, and the suction chamber. These three chambers have been integrated into one device in modern chest tube drains (e.g. the Pleur-evac) but we can still conceptualize them as being connected in series to the patient. The collecting chamber is connected to the chest tube and it collects the drainage from the patient’s chest cavity. To facilitate drainage collection the collecting chamber is connected to a suction chamber which is traditionally set at -20 cm H2O The water seal chamber is connected between the collecting chamber and the suction chamber. The water seal chamber acts as a one way valve which prevents air from being entrained into the patient from the environment.
Cricothyroidotomy
A bougie-assisted cric utilizes a bougie to intubate the trachea through an incision in the cricothyroid membrane. This simplifies the traditional 5-step method of cricothyroidotomy and the bougie can provide confirmation that your tube is in the airway.
Lateral Canthotomy
Orbital trauma + proptosis + vision loss = ED lateral canthotomy + cantholysis
Thoracotomy
Penetrating chest trauma + Loss of vitals < 10 minutes prior = ED thoracotomy
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Additional Resources:
The following are long form videos and articles which expand on the topics above. Dedicate some time to these articles to become a maestro of ED procedures.
Airway
- Rich Levitan’s airway lecture (75 minutes): http://emcrit.org/podcasts/rich-levitan-airway-lecture/
- Ruben Strayer’s airway lecture (63 minutes): https://vimeo.com/12440392
Chest tube
- Further explanation of chest tube drains: http://emedicine.medscape.com/article/1503275-overview#a5
- Pigtail catheter insertion article: http://epmonthly.com/article/pigtail-insertion/
- Secure the tube with the Farina method (double hitch knot): http://calsprogram.org/manual/volume2/Section6_BreathingSkills/02-BrSk1ChestTubeInsert13.html
Cricothyrotomy
- Rich Levitan’s cric lecture (26 minutes): http://emcrit.org/podcasts/levitan-surgical-airway/
Lateral Canthotomy
- EM Curious blog post regarding the lateral canthotomy: http://www.emcurious.com/blog-1/2014/9/25/the-lateral-canthotomy
Thoracotomy
- Scott Weingardt’s thoracotomy lecture (37 minutes): http://emcrit.org/podcasts/procedure-of-thoracotomy/
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These videos are all available in the public domain and were found on reliable resources. Follow the links for author info. You should never attempt any medical procedure for which you have not been trained and which you have not been certified to perform. The videos are intended to augment practical learning, but cannot replace formal training.
[/et_pb_text][et_pb_team_member admin_label=”Person” name=”Dr. Chris Barsi” position=”Author, Chief Resident” image_url=”http://theempulse.org/wp-content/uploads/2015/11/Christopher-Barsi.png” animation=”off” background_layout=”light” twitter_url=”https://twitter.com/ERHoagie” use_border_color=”off” border_color=”#ffffff” border_style=”solid” saved_tabs=”all”]
Dr. Barsi is currently a Chief Resident at LIJ Emergency Medicine.
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