This video is by Stuart Myers, an Orthopaedic hand and wrist surgeon from Sydney.  If you are a health professional looking for more free online education resources related to hands and wrists, head over to Stuart’s website: myhand.com.au

The post Digital nerve block – intermetacarpal technique appeared first on ED Procedures.

What could go wrong if you sit a patient in a chair during a painful procedure:

WHOOPS!

Bad for patient because:

• #embarrassing
• potential injury
• failed procedure

Bad for you because:

• #veryembarrassing
• failed procedure

SO INSTEAD:

• Put the PATIENT ON THE BED!
• Use the chair and save your back

IF THE PATIENT FAINTS

• They are safe
• Gently lay them flat

So with that in mind, please follow these simple steps when performing ANY procedure that involves needles, pain or the sight of blood.

• Do NOT do painful procedures with patient sitting on a chair!
  • Use the BED for the patient’s BODY!
  • If there are no beds/trolley available – the procedure can wait
• Do not bend over a patient while doing a procedure
  • Use the CHAIR for YOUR body
  • And/or raise the bed so you are not straining your lower back
• All friends/relatives MUST
  • Leave the room OR be seated during procedures

The post PPPP: Patient Positioning for Painful Procedures appeared first on ED Procedures.

Here’s our tips:

1. Dilate the pupil – we’re often reluctant to do this in ED, but seriously, would an Ophthalmologist give an opinion through an un-dilated pupil? Probably not. Your view of the retina will be far better when the pupil is dilated, so go ahead and do it.
2. Get the patient to sit looking straight ahead, and come in from around a 15-20 degree angle for the first view – this will land you directly on the optic disc.
3. Then ask the patient to look straight into the light, and you will see the macula.

It really is that simple, and once you get the hang of it, you will achieve far superior views than you ever have with a standard ophthalmoscope!

The post Pan Optic Ophthalmoscope for fundoscopy appeared first on ED Procedures.

The post Tono-pen AVIA for intra-ocular pressure measurement appeared first on ED Procedures.

(NB The video still works, just click “play”!)

The post Own The Oxylog 3000 Plus! appeared first on ED Procedures.

These are must-have guides for anyone working in the ED or doing retrieval or transport with the Oxylog 3000.

Download the Oxylog 3000 complete guide

This includes specific instructions for:

• Volume controlled ventilation
• Pressure controlled ventilation
• Non-invasive ventilation

Using the Oxylog 3000 Plus.

Also be sure to check out George’s excellent video: Own the Oxylog 3000!

The post Oxylog 3000 Plus – free downloadable ventilator setting guides appeared first on ED Procedures.

So we set up round 2, testing the effect of a fluid warmer, an IV bung and a 3-way tap on flow rates through an 8.5Fr RIC line attached to a high pressure rapid infuser system.

We also dismantle an IV bung to see just why they slow flow so much!

Check out the video to see the results.

The post Large bore IV access showdown – Round 2 appeared first on ED Procedures.

“2 large bore IVs”

We’ve also all been taught that “short and thick does the trick” due to Poiseuille’s Law which states that flow is directly proportional to the fourth power of the radius, and inversely proportional to the length:

But despite our best efforts we couldn’t find a direct comparison of the various types of IV cannulas and catheters we used at work to see which one is actually best. We had unanswered questions that needed answers.

Which IV cannula/catheter delivers IV fluid the fastest?  
How much faster is a 14G compared to a 16G, 18G or 20G?
Is a standard 14G faster than a RIC line or sheath introducer?
And just how much slower is a central line at delivering fluid?

Behold, the Large Bore IV Access Showdown. We’ve hooked up all of the major types of IV lines you’re likely to find in an average Australian ED to a rapid infusor device, and timed how long it took to pump through a litre of saline.

So which line was best? You’ll have to watch the video and find out!
(If you can’t stand the wait, skip ahead to the results at the 10:40 mark)

So the 8.5Fr RIC line was the winner!

Here’s our video on how to insert a RIC line

Here’s our rather unscientific, but hopefully visually useful comparison of the relative speeds at which fluid can be pumped through the different lines in our test:

Click to enlarge

And here’s our table of results:

Please feel free to download, share, embed, or otherwise distribute the video and results. And feel free to run your own trials and let us know if they’re similar or different!

For more information on the various types of large bore IV access check out our post on the ETM Course site on large bore vascular access devices. The astute will have noticed that we didn’t use a MAC-line (multi-lumen access catheter) in this test. This was because we don’t stock them in the ED we did the test in, and they are rarely (if ever) found in your average Australian ED, however most if not all of the other lines are.

The post Large bore IV access showdown: does short and thick really do the trick? appeared first on ED Procedures.

This is a comprehensive video on the practical initial assessment and management of epistaxis in the ED. It’s a long video (around 22 minutes) but covers pretty much everything you need to know to effectively manage epistaxis in the ED setting, including equipment, drugs, patient positioning, lighting and magnification and multiple methods of nasal packing.

(Huge thanks to Maddie Young for being such a sporting mock-patient!)

The post Epistaxis management in the ED – the definitive guide appeared first on ED Procedures.

• The (drug-free) Cunningham method
• Kochers method
• Scapular Manipulation
• Modified Milch
• Zero Position

As well as some tips on troubleshooting tricky shoulder dislocations.

We’ve already posted the first video, and we recommend you start with this (Neil’s excellent talk on all things shoulder dislocation) and will re-post the Cunningham Method video with some tips soon as well.

[Youtube_Channel_Gallery user=”shoulderdislocation” videowidth=”580″ ratio=”16×9″ theme=”light” color=”white” autoplay=”0″ rel=”0″ showinfo=”1″ maxitems=”16″ thumb_width=”125″ thumb_ratio=”16×9″ thumb_columns_ld=”2″ title=”1″ description=”0″ promotion=”0″ pagination_show=”0″ description_words_number=”6″ thumb_order_thumb=”4″]

The post Neil Cunningham’s shoulder reduction video gallery appeared first on ED Procedures.