Program

Airway Management Lectures

The airway management lectures are a critical part of the cadaver-based Emergency Medicine training course, focusing on essential techniques and scenarios encountered in emergency settings:

Managing and Owning the Airway: This segment covers the fundamentals of airway management, emphasizing the importance of maintaining a clear airway and the initial steps to take in emergency situations, including: can’t intubate/can’t oxygenate scenarios. Techniques for assessing and securing the airway, including basic maneuvers and the use of airway adjuncts, will be covered.

The Challenging Airway: This part addresses scenarios where standard airway management techniques are difficult or fail. It includes strategies for recognizing a difficult airway, tools and techniques for managing these situations, and decision-making processes to ensure patient safety.

Surgical Airway Techniques – Percutaneous Tracheostomy and Cricothyrotomy : Surgical interventions (front of neck access) are discussed as last-resort options for airway management. The lecture will cover indications, contraindications, techniques, and complications associated with surgical airway access.

These lectures aim to equip participants with the knowledge and decision-making skills necessary to manage airways in critical scenarios effectively, enhancing their competency in emergency medicine practice.

Peripheral Nerve Blocks Lectures

These lectures aim to provide participants with a detailed understanding of the indications, techniques, and complications associated with performing peripheral nerve blocks, enhancing their skill set for pain management and procedural anesthesia in emergency settings.

Nerve Block pharmacological considerations: This session will cover the pharmacology, drug selection, and administration of various agents used in nerve blocks, including local anesthetics and adjuncts. Emphasis is on understanding the mechanism of action, effective doses, onset times, duration, and potential side effects.

The lectures on peripheral nerve blocks are broken down into sections designed to provide comprehensive knowledge on the use of nerve block techniques and medications/agents used, with a focus on different anatomical regions:

Upper Extremities: This segment focuses on nerve blocks for the upper limbs, crucial for procedures involving the arm, forearm, hand, and shoulder. Techniques for blocks such as the brachial plexus block (interscalene, supraclavicular, infraclavicular, and axillary), ulnar, radial, and median nerve blocks will be discussed.

Trunk: The trunk session covers nerve blocks used for the torso, potentially including the intercostal nerve block for rib fractures, paravertebral blocks, Erector spinae block and serratus anterior nerve block.

Lower Limb: This session is dedicated to nerve blocks for procedures involving the lower extremities. Blocks such as the femoral nerve block, sciatic nerve block (and its approaches), and blocks for the ankle and foot will be covered, focusing on indications, techniques, and safety considerations.

Resuscitative Lectures

The PART B lectures in the Cadaver-Based Emergency Medicine Training Course focuses on critical emergency procedures related to trauma. These lectures are designed to provide in-depth knowledge and technical skills necessary for emergency medicine practitioners. The key areas covered include:

Chest Tube Insertion

Indications and Contraindications: This part of the lecture will focus on when and why chest tube insertion is necessary, such as for pneumothorax, hemothorax, or pleural effusion, and any contraindications to be aware of.

Techniques: Step-by-step instruction on performing a chest tube/intercostal catheter insertion, including anatomical landmarks, surgical technique, and the choice of equipment.

Post-Procedure Care: Guidelines for managing the chest drain, monitoring the patient, and criteria for removal of the chest tube.

Resuscitative Thoracotomy

Indications: The lecture will outline the scenarios where an emergency thoracotomy might be warranted, such as life-threatening chest\abdominal injuries.

Procedure Overview: Detailed walk-through of the thoracotomy procedure, including incision sites, surgical access to the thoracic cavity, and critical structures to be aware of. Main procedures will be discussed and trained: pericardial tamponade release, direct cardiac massage, clamping of thoracic aorta.

Risks and Complications: Discussion on the significant risks associated with thoracotomy, including infection, injury to thoracic organs, and postoperative care challenges.

Each of these topics is crucial for Emergency Medicine practitioners, as they involve life-saving procedures that require precision, a deep understanding of thoracic anatomy, and the ability to quickly assess and respond to rapidly evolving clinical situations. The lectures are complemented by hands-on sessions on cadavers, allowing participants to apply what they’ve learned in a controlled and realistic setting.

Access – RIC Lines

Rapid Infusion Catheter (RIC) Lines:

RIC lines are specialized intravenous catheters designed for the rapid infusion of fluids. They are particularly useful in emergency and critical care settings where rapid volume resuscitation is necessary, such as in cases of severe dehydration, hemorrhagic shock, or other conditions requiring rapid fluid administration.

Design and Functionality: RIC lines are typically larger in diameter than standard IV catheters, allowing for a higher flow rate of fluids. They may also be designed for insertion into central veins, such as the femoral, internal jugular or subclavian veins, to accommodate rapid infusion rates without causing damage to smaller peripheral veins.

Indications and Use: The primary indication for a RIC line is the need for rapid fluid resuscitation. This can include aggressive rehydration in critically ill patients, rapid blood transfusion in trauma or surgical patients, and administration of large volumes of fluids in patients with severe electrolyte imbalances.

Procedure: The insertion of a RIC line is similar to that of other central venous catheters, involving sterile technique, ultrasound or anatomical landmark guidance, and careful monitoring for potential complications such as pneumothorax, arterial puncture, or infection.

Advantages and Limitations: The main advantage of RIC lines is their ability to facilitate rapid volume resuscitation. However, their use is limited by the need for skilled personnel for insertion, potential for serious complications, and the requirement for central venous access, which may not be feasible in all patients.

Intraosseous (IO) Access

Intraosseous (IO) access involves the insertion of a needle into the bone marrow cavity, providing a non-collapsible entry point into the systemic venous system. This method is used when traditional peripheral or central venous access is difficult or impossible to obtain in emergency situations.

Indications: IO access is indicated in emergency situations where rapid vascular access is critical, and traditional IV access is not feasible or has failed. This includes cardiac arrest, shock, severe dehydration, or trauma patients.

Sites for IO Insertion: The most common sites for IO insertion include the proximal tibia, distal femur, and the humeral head. The choice of site depends on the patient’s age, the clinician’s experience, and the specific clinical situation.

Procedure: IO access is achieved using a manual or power-driven needle, which is inserted into the bone marrow cavity. Once access is confirmed, fluids, medications, and blood products can be infused directly into the marrow, from where they enter the systemic circulation.

Advantages: The primary advantage of IO access is the speed and reliability of access in critical situations. The bone marrow cavity provides a non-collapsible entry point that is not affected by peripheral vasoconstriction.

Limitations and Complications: While IO access is generally safe, potential complications include infection, injury to surrounding structures, compartment syndrome, and osteomyelitis. It is also a temporary access solution, typically recommended for use up to 24 hours, after which alternative vascular access should be established.

Both RIC lines and IO access are essential tools in the armamentarium of emergency and critical care medicine, offering solutions for rapid vascular access in situations where traditional methods may be inadequate or impossible. Their use requires specific training and familiarity with the indications, techniques, and potential complications associated with each method.

Saphenous vein cutdown: This simple, yet potentially life-saving venous access technique will be demonstrated and then practiced by course participants.