ED Procedures Lab
Goals:
-
Students will gain knowledge of the indications and contraindication for and proficiency in the performance of basic ED procedures. These include the following
- Establishment and use of peripheral intravenous (iv) lines)
- Phlebotomy techniques
- Basic techniques for accessing indwelling venous catheters
- Foley catheter placement
- Nasogastric tube placement
- Basic sterile technique
Objectives:
-
Students will complete the ED procedures lab and successfully accomplish the following on a model
- Placement of an iv line
- Venous access for phlebotomy
-
Students will demonstrate proper technique for site preparation for placement of an iv and / or venous phlebotomy
-
Students will describe and demonstrate how to draw blood from an indwelling device such as a PICC line or Hickman catheter
-
Students will describe and demonstrate appropriate sterile technique for placement of a foley catheter. They will be able to list three contraindications to placement of a urinary catheter
-
Students will describe and demonstrate appropriate technique for placement for a nasogastric (NG) tube. They will be able to list three contraindications to its placement.
Wound Care Lecture & Suture Lab
Supplemental reading: Hamilton, Chapter 49
Goals
- Understand the anatomical considerations of the skin that dictate technique for wound closure
- Understand how different mechanisms of injury result in different types of wounds
- Recognize the different risks for infection that different wound types have and understand the important methods of minimizing infectious risk
- Understand various wound closure techniques (including suture, steri-strips, wound glue, staples) and their indications and contraindications
- Learn appropriate technique for wound preparation and closure
- Understand the indications and contraindications of available local anesthetic options including local, regional and topical medications
Objectives
- List the three layers of the skin and identify the region responsible for wound healing
- List three things that impede wound healing
- Identify four types of wounds with high infection rates
- Describe why irrigation and inspection of a wound is important
- Calculate the maximum doses of lidocaine with and without epinephrine given a patient’s weight.
- What is the benefit of using lidocaine with epinephrine? What are the contraindications to its use?
- List 3 things that can be done to reduce the pain from injection of local anesthestic.
- What is TAC / LET? What are the indications and contraindications for its use in local anesthesia?
- Describe when to use each of the following wound closure methods
- Monofilament, nonabsorbable sutures
- Absorbable sutures
- Silk sutures
- Staples
- Dermabond
- Be able to execute and describe appropriate utilization of each of the following suture and wound closure techniques
- Simple interrupted sutures
- Running suture
- Mattress sutures
- Deep sutures
- Wound staples
- Dermabond
- Describe when prophylactic use of systemic antibiotics in wound care is indicated.
- Given a wound location, identify the appropriate time for suture removal
- Provide appropriate discharge instructions and precautions after wound care in the ED
References:
Trott A. Wounds and Lacerations: Emergency Care and Closure. St. Louis: Mosby-Year Book, 1991: 5-18.
Shock and Basic Resuscitation Principles Lecture
Supplemental Reading:
- Hamilton, Chapter 4
- Rivers, et al. Early Goal-Directed Therapy in the Treatment of Severe Sepsis
and Septic Shock. New England Journal of Medicine, 345 (19), 2001.
Goals
- Students will be able to recognize the major clinical manifestations of shock
- The student will be able to define shock and its major subtypes including hypovolemic, septic, cardiogenic, and obstructive etiologies
- Students will gain a basic understanding of the resuscitative measures to be undertaken when a patient presents in shock.
- Students will understand the benefits and limitations of major vascular access devices used in the ED including peripheral IVs and central lines.
- Students will understand the major types of fluid resuscitation that can be undertaken and their indications and contraindications as well as general guidelines for their use.
- Students will understand how extremes of age and comorbidities may alter the presentation of a patient in shock
Objectives
- Define shock and list its major causes
- Describe the major clinical findings in a patient in shock. Describe how these findings differ depending on the etiology of shock Describe the role of laboratory studies in the assessment of shock and be able to describe the role and limitations of each of the follow studies in a patient in shock – ABG, basic, CBC, cultures, coags, lactate
- Identify the major vasopressor agents and describe the general indications for their use.
- Describe the differences between peripheral and central venous access. Describe the benefits and limitations of each include rate of volume administration, ease of access, and complications of placement.
- Describe appropriate ED monitoring of a patient in shock
- Identify the major types of fluid for volume resuscitation and the situations in which each is optimally used. Describe how to determine the effectiveness of fluid resuscitation.
- Describe how the causes of shock differ based on the age of the patient (pediatric, young adult, elderly adult) and how their clinical presentation may differ with regard to vital signs, physical exam findings, and laboratory findings.
Top
Airway Lecture & Lab
Supplemental Reading: Hamilton, Chapter 2, 27
Goals
- Students will gain proficiency in the basic assessment of the airway.
- Students will have an understanding of different methods available for airway management and their major indications and contraindications.
- Students will have an understanding of the factors that place a patient at risk for airway compromise.
- Students will have an understanding of the differences between adult and pediatric airways and how those differences affect airway management options
- Students will gain a basic understanding of rapid sequence intubation (RSI)
Objectives
- Identify patient features that place an individual at risk for airway compromise.
- Identify five specific indications for airway management
- Describe the major elements of the primary survey of Airway and Breathing
- Describe how to determine whether an airway is adequately protected.
- Describe characteristics of common oxygen delivery devices such as nasal cannula, Venturi mask, non-rebreather mask, BiPap/CPAP, and endotracheal tubes. Be able to visually identify each device.
- Describe methods to manually open the airway and the indications and contraindications for their use particularly with regard to patients with potential cervical spine injury.
- List four anatomic predictors of a difficult airway
- Identify the most common serious complications associated with endotracheal intubation
- List the major steps in a rapid sequence intubation.
- Identify the major pharmaceutical components used in a rapid sequence intubation.
- List and describe three rescue modalities for a failed attempt at endotracheal intubation
- Identify the major differences between pediatric and adult airway management with regard to anatomy, physiology, pharmacology, and appropriate rescue measures.
- In the laboratory setting, demonstrate the ability to successfully perform the following airway management maneuvers
- Sellick maneuver
- Jaw thrust
- Chin lift
- Bag-valve-mask ventilation
- Nasotracheal intubation
- Orotracheal intubation in both pediatric and adult settings.
Top
Introduction to ACLS & Arrhythmias
Supplemental Reading: Hamilton, Chapter 3
Goals
- Students will be familiar with the common dysrhythmias seen in the ED including ventricular fibrillation, ventricular tachycardia, asystole, atrial fibrillation, PEA, and heart block as well as with initial treatment modalities.
- Students will understand the limitations of CPR and the indications for cessation of resuscitation efforts.
Objectives
- Identify the most common dysrhythmia presenting as cardiac arrest. Why is early treatment important?
- List five important pieces of information to be obtained rapidly from EMS personnel when a patient is brought in with cardiac arrest.
- Given an adult in V-fib, pulseless V-tach, or asystole identify the appropriate interventions for the dysrhythmia.
- List three reversible causes for PEA and their appropriate interventions
- Given an monitor tracing, correctly identify Vfib, Vtach, asystole, sinus tach, atrial fibrillation, SVT and complete heart block.
- List three possible interventions for a symptomatic patient with a heart rate of 25 bpm.
- Describe three possible interventions for an alert patient who presents in SVT.
- Participate in a code using the HPS
Top
Headache Emergencies
Computer module – active as of fall 2008
Supplemental Reading: Hamilton, Chapter 32, 33, 34
Goals
- Students will gain a basic understanding of the diagnosis and initial management of common and life-threatening emergencies that present with a chief complaint of headache including life threatening causes of headache, seizures, meningitis, and stroke.
- Students will gain familiarity with critical findings on lumbar puncture and the indications for performing this invasive test
Objectives
-
In a patient with headache, list five key components of the physical exam that you need to perform and the relevant findings you may find in each exam section.
-
Describe characteristics of headache that elicit concern for subarachnoid hemorrhage, neoplastic processes, intraparenchymal hemorrhage and meningitis.
-
Identify the ED workup for each of the processes listed in 2.
-
Given LP results, correctly identify what process each is associated with.
-
Describe the initial ED treatment algorithm for meningitis. Identify appropriate initial antibiotic choices
-
Explain why workup for subarachnoid hemorrhage includes both a CT and an LP and describe the classic findings on each study.
-
Given LP findings differentiate between a subarachnoid hemorrhage and a traumatic tap.
Basic Approach to Trauma
Supplemental Reading: Hamilton, Chapter 41, 42, 43, 44
Goals
- Students will gain an understanding of the epidemiology of traumatic injury and the importance of rapid assessment and stabilization to prognosis and survival.
- Students will understand the basic ATLS approach to trauma including the ABCDE pneumonic
- Understand the basic principles of C-spine stabilization and clearance
- Students will be able to initiate trauma resuscitation including ABCs, fluid management, and routine imaging.
- Understand imaging modalities including CT, Ultrasound, available to assess for intra- abdominal injuries
- Students will know where occult blood loss can occur in a traumatized patient.
- Students will recognize classic traumatic chest x-ray findings for catastrophic injuries including pneumothorax, diaphragmatic rupture, and aortic rupture.
Objectives
- How is the “A” in the trauma ABC’s modified from the medical ABC’s?
- Estimate the blood able to be lost into the following body compartments as a result of injury
- Pelvis
- Hemithorax
- Abdomen
- Femur
- Lower leg
- Describe the important findings on a CXR that suggest a traumatic aortic rupture
- Describe the initial resuscitation of a traumatized patient with a
- blood pressure of 80/40 and heart rate of 120.
- blood pressure of 80/40 and heart rate of 60 who has a GCS of 5.
- Demonstrate the ability to apply CTLS precautions and, given a clinical scenario, determine whether a spine can be clinically cleared.
- Discuss when a head CT is warranted in the evaluation of a traumatized patient.
- List 4 locations where major occult blood loss can occur in a traumatized patient.
Top
Fractures and Splinting
Supplemental reading: Hamilton, Chapter 46, 47
Goals
- Introduce students to the basic concepts of splinting, including importance of neutral positioning and appropriate padding.
- Learn to assess an injured extremity for fracture and neurovascular patency.
- Recognize common fracture patterns in pediatric and adult patients.
- Learn indications for emergent orthopedic consultation.
Objectives
- Describe the Saltar-Harris system to categorize pediatric fractures
- List 3 indications for emergent orthopedic consultation
- Demonstrate neutral position for a splint of wrist and ankle. Describe how to apply a sugar tong splint and posterior ankle mold.
- List 3 complications of an inappropriately placed splint.
- Describe the role of pain management in caring for someone with a fracture.
- Discuss when to obtain an x-ray of an injured extremity.
- Given a film of a long bone fracture, describe the fracture as you would to a consultant.
Top
The Febrile Child
Computer Module
Supplemental Reading: Hamilton, Chapter 26
Goals
- Students will understand why fever has different significance based on a child’s age.
- Students will learn how to recognize physical exam and historical findings that suggest a child has a potentially life-threatening infectious cause for the fever
- Students will learn how to initiate a basic fever workup based on the child’s age and will recognize the importance of looking for occult infection.
- Understanding the different pathogens involved in children’s febrile illnesses and how they vary with age
Objectives
- Describe why fever in an infant of less than four weeks of age is potentially serious
- List five physical exam findings that may be found in a child considered “toxic”.
- List five physical exam findings in a child that may be described as “nontoxic”
- Given a child’s weight, calculate appropriate doses of acetaminophen and ibuprofen.
- A child presents with a temperature of 102F, describe the ED workup for a three week old, a 6 month old and a four year old.
- Given a child of 2 weeks, 3 months and 2 years, list the 3 major infections pathogens and common sites of occult infection.
Top
Basic Concepts in Toxicology
Supplemental Reading: Hamilton, Chapter 15, 16
Goals
-
Gain an understanding of the basic approach to a poisoned or overdosed patient
-
Understand the epidemiology of accidental and intentional overdoses
-
Understand the role of GI decontamination (lavage, ipecac, charcoal) and its limitations
-
Recognize the importance of airway protection when treating an overdose patient
-
Recognize the most common overdoses and classic toxidromes seen in the ED including acetaminophen, sympathomimetics, and anticholinergics.
Objectives
- Describe the toxidromes associated with sympathomimetics and anticholinergics and how to distinguish clinically between the two entities
- Describe the utility and limitations of a serum acetaminophen level in an overdosed patient and its predictive value in terms of development of liver toxicity
- Given an overdosed patient, describe
- Airway management
- GI decontamination measures
- Initial labs indicated
Management of the Violent Patient
Reading: Violence article
Goals
-
Be able to identify patients and individuals who are at high risk to display aggressive or violent behavior toward medical personnel
-
Be able to initiate basic measures to insure one’s personal safety when confronted with a patient acting in an aggressive manner
-
Understand the hierarchy of methods used to control an individual’s aggressive behavior
Objectives
-
List 5 warning signs that an individual may potentially become physically threatening to health care practitioners in the ED.
-
Describe measures that can be incorporated to protect your personal safety when confronted by a violent individual in the ED
-
In order of use, list 4 measures that can be taken to control a violent individual indicating which should be used first and which is the most invasive.
-
What are the rules for use of physical restraints on a patient.
-
List 3 medical conditions that sometimes present as violent behavior (sepsis, toxic encephalopathy, hypoglycemia)
Environmental Emergencies
Supplemental Reading: Hamilton, Chapter 17, 18
Goals
-
Students will understand various types of burns and be able to initiate treatment including having an understanding of when transfer to a specialized center is indicated.
-
Understand the importance of rapid airway assessment and management in a patient with burns and/ or smoke exposure
-
Recognize heat syndromes including heat exhaustion and heat stroke and be able to initiate appropriate treatment and laboratory evalution
-
Recognize the spectrum of physical findings with hypothermia and understand how the degree of hypothermia changes the emergency management of a patient.
Objectives
- Describe the physical findings associated with different types of burns including superficial, partial, and full thickness
- List 3 indications that a patient should be transferred to a burn center
- When examining a patient with smoke inhalation, describe why assessment and early intervention on the airway are important. List three historial and examination features that would suggest need for intubation.
- Calculate initial fluid requirements for a burn patient.
- Describe how to warm up a hypothermic patient with a core temperature of 93F. A patient with a core temperature of 85F and impending cardiac arrest.
- Define heat exhaustion and heat stroke. How do you clinically differentiate?
- Describe 4 simple maneuvers that can be rapidly performed in the ED, to cool down a patient.
|
