Procedures

Noam is an EP with a particular love for critical care procedures, physiology and all else. He also has a strong interest in ED efficiencies, specifically equipment and supply management.

Dr. Brandon Ritcey is an emergency physician at the Ottawa Hospital and an assistant professor at the University of Ottawa. He is also the Assistant Director of the POCUS fellowship in Ottawa.

Procedure Logistics: Tactical considerations for getting high stakes procedures done right, and fast

So you want to place a femoral art line in a PEA arrest. Okay, where’s the fem art line catheter? How will you secure it? < Clears space on patient’s abdomen for equipment > Wait, where’s the transducer bundle? Oh sh*t the patient moved. Can we get a new set-up? There’s a better way to perform high stakes procedures in the ED. We’ll tell you all about it.

Learning Objectives

Overcome learned helplessness in health care: Procedure logistics don’t have to be hard (we just make it that way)
Recognize the role for interprofessional advocacy towards the creation of purposefully designed resuscitation equipment, carts, bundles as a required element of patient and team safety
Describe the simulation-informed design process as it relates to specific high stakes procedures

Pearls

You don’t do procedures alone: Engage an inter-professional team in resuscitation equipment design
One place for everything, everything in one place
Novel solutions to equipment and stocking are needed: A responsible individual, and a reliable process

Ultrasound guided nerve blocks you absolutely should be doing

Review how to perform several high yield US-guided nerve blocks that ER clinicians should be doing now and discuss a couple more that could be game changers in the future.

Learning Objectives

Understand how to safely perform US-guided nerve blocks.
Learn how to perform several nerve blocks
Learn about new nerve blocks that may become useful in the future.

Pearls

Inject with saline first then add local anesthetic.
Prepare nerve block kits with all the common equipment to save time.
Anesthetic volume is more important than concentration.

How to be successful at curing BPPV

The Epley maneuver for BPPV has one of the lowest NNT in all of medicine. But to achieve this, it must be done on the right patient, the right way. Barriers will be identified, and strategies to improve success discussed.

Learning Objectives

Recognize which patients who would benefit from particle repositioning maneuvers.
Identify which ear and canal is involved in BPPV
Select strategies to deal with difficult scenarios.

Pearls

Horizontal nystagmus seen during a Dix-Hallpike test is not a positive DHT.
Don’t perform the DHT on patients with spontaneous nystagmus.
Re-test your patients after maneuvers to gauge success.

Why won’t this %@$! Arterial Line Work?

You have inserted the A-line, so now what? Review how to prime, calibrate, zero and troubleshoot the A-line transducer set to obtain accurate readings.

Learning Objectives

Discuss the indications to place an arterial line in the emergency department
Learn how to set up the pressure transducer and troubleshoot the most common problems
Reduce complications from placing arterial lines

High Acuity, Low Opportunity (HALO) procedures: Taking the Leap

Pulse quickens. Hands start to tremble. Doubt sets in: am I really doing this? Some procedures in Emergency Medicine don’t come around all that often. Being prepared for when they do is essential. Let’s talk about what that means and how to do it.

Ring Removal

In this brief session we will cover the indications in 30 seconds of less and then move on to the different materials rings can be made of and their characteristics. We will review the basic and a few not so basic tools complete with videos of their use in the ED. A brief not on non-finger rings and their removal. Tips on jewelry preservation and the importance of sentimental ring removal. The next time a patient needs a ring removal, you will be the right person to call!

Learning Objectives

Know the indications for ring removal in the ED
Recognize the importance safe, comfortable and cautious removal of rings
Have a variety of tools to remove variety of rings

POCUS-Guided Arthrocentesis

During this multimedia presentation, participants will learn how to perform a point-of-care ultrasound guided arthrocentesis of the ankle, elbow and wrist. The technical approach including important landmarks and how to avoid common pitfalls will be discussed. Participants will leave with the tools to safely complete these procedures in their own department.

Learning Objectives
Describe the basic anatomy in order to perform a POCUS-guided arthrocentesis of the ankle, elbow and wrist joint.
Describe the technical approach to a POCUS-guided arthrocentesis
Describe common pitfalls in performing the procedure

Headache Nerve Blocks

A brief overview of various interventional techniques and injections that can be used to treat acute headache syndromes and craniofacial pain in the ED.

Learning Objectives

To identify the indications for nerve blocks in the face, head, and neck
To safely perform the sphenopalatine ganglion block, c-spine trigger point injections, occipital nerve blocks, and others.
To understand the c-spine anatomy that makes high cervical trigger point injections high-risk.

Pearls

Use SPG block for periorbital pain
Use combination of occipital nerve block and c-spine trigger point injections for cervicogenic/occipital headaches
Use caution with c-spine trigger point injections