clinical procedures in the ED

see also:

cardiopulmonary resuscitation:
- cardiac arrest and asytole
- neonatal resuscitation

reduction of dislocated shoulder:
- Reduction techniques for ant/inf shoulder dislocation
- EMRAPTV Episode 28: Luxatio erecta

reduction of dislocated prosthetic hip:
- Austin EDteaching.com - Whistler technique mp4 video

central line placement
- Clinical Notes - Central Line Placement: A Step-by-Step Procedure Guide with Photos
- Clinical Notes - Central Line Placement with Ultrasound Guidance: A Step-by-Step Procedure Guide with Photos
- State Uni of NY, Buffalo
- EMRAPTV Episode 22: Supraclavicular approach to central lines
- EMRAPTV Episode 32: CVP measurement - Old and new school methods of CVP monitoring
- EMRAPTV Episode 56: Types of central lines
- NB. central lines should generally be performed under US guidance, if unavailable, then consider the safer femoral vein route, although these should be removed within 24 hours of placement.
- NB. central venous lines (CVC's) must be removed when the patient is supine NOT when sitting up otherwise there is risk of air embolism.
- Blue Phantom manikin for practicing internal jugular line placement using US

thoracostomy
- EMRAPTV Episode 16: Pre-hospital needle thoracostomy and ED care
- EMRAPTV Episode 46: Pneumothorax and Heimlich valve

thoracentesis (pleural tap)
- Clinical Notes - Thoracentesis: A Step-by-Step Procedure Guide with Photos
- Loyola Uni - video

arthrocentesis (joint aspiration)
- knee joint
  - EMRAPTV Episode 5: Knee arthrocentesis
  - anteromedial approach:
    - medial aspect mid-patella with leg extended
    - preferred approach for rheumatologists, especially if giving steroid injections
    - medial capsule is generally looser and easier to penetrate than the lateral side with less risk of impacting bone/cartilage
  - suprapatella bursa approach
    - easiest for those with obvious suprapatellar effusions - more difficult in obese patients
    - 1cm sup and 1cm lateral to proximal edge of patella - needle parallel to bed with leg extended
    - risk of intratendinous injection or pain if needle not angled correctly posteriorly and superiorly
  - infrapatella approach
    - below patella and posterior to patellar tendon whilst patient sitting with knee flexed 90deg
    - narrower target space posterior to the patellar tendon; higher risk of intratendinous or intra‑bone placement if not careful
    - used if other approaches contra-indicated
  - ultrasound guided provides better accuracy and potentially less pain in those with smaller effusions
  - for large effusions, use a stop cock to allow changing syringes to gain more aspirate for effusion relief

suprapubic aspiration and catheterisation
- suprapubic catheterisation
- Emedicine.com