Saturday, April 28, 2018

Emergency Reflex Action Drills

EMCrit - April 24, 2018 - By Lauria M, Reid C and Weingart S
Specific ERAD Examples
  1. Response to Grade III or IV Cormack-Lehane View During Intubation – George Kovacs (@kovacsgj) developed an excellent ERAD in response to Grade III/IV view on direct laryngoscopy in three steps: 1) lift the occiput beyond sniffing position and align axes, 2) use external laryngeal manipulation to optimize view, 3) Use Two Hand lifting if unable to manage with one hand. Or as Scott teaches this ERAD, HEAD-NECK-HANDS
  2. Response to Sudden and Profound Hypotension – Scott uses this immediate action in response to a patient whose hemodynamics suddenly deteriorate and is peri-arrest: 1) grab an amp of cardiac epinephrine (100 mcg/cc) from the code cart 2) push 0.5 cc to maintain hemodynamics while you determine the cause for acute decompensation and develop a plan for definitive fix. CART-EPI-HALF
  3. Response to Hypoxia in the Awake Patient – Rich Levitan (@airwaycam) teaches the OOPS mnemonic to address hypoxia: 1) OXYGEN ON via nasal cannula, 2) PULL the jaw forward/jaw thrust 3) SIT patient up.
  4. Response to Cardiovascular Collapse in Patient on ECMO – The @EDECMO team suggest the following as immediate response to blood spraying around the room with a patient on ECMO: 1) clamp the arterial cannula 2) clamp the venous cannula 3) Prepare Epinephrine & Change Vent Settings. CLAMP-CLAMP-RESUSCITATE
  5. Response to Profound Deterioration on a Ventilator – Scott teaches this 3 part ERAD to overcome vent manipulation fixation as the patient crashes: 1) Bag with BVM (ask for a PEEP valve as soon as possible) 2) Call for Help—often fixing this problem is a 2-person job 3) Troubleshoot with DOPES. BAG-HELP-DOPES
  6. Response to Loss of Palpable Pulses in a Blunt Polytrauma Patient – The Sydney HEMS team will 1) Attempt to arrest massive haemorrhage, 2) Perform a ‘cold’ tracheal intubation, 3) Make bilateral open thoracostomy incisions, and 4) infuse packed red blood cells. STOP-TUBE-CUT-INFUSE