EMERGENT SURGICAL PROCEDURES Julie Margenthaler MD Emergent Surgical

EMERGENT SURGICAL PROCEDURES Julie Margenthaler, MD

Emergent Surgical Procedures

Stations • • • Chest tube placement Airway management IV/arterial access Central line access Suturing*

Chest tube placement -drains fluid or air from the pleural space -inserted at the 4 th or 5 th intercostal space, anterior axillary line -tube is directed to the apex and posterior

Chest tube placement

Steps of CT insertion

CT insertion: Positioning/Prepping

CT insertion: Local anesthetic

CT insertion: Skin incision

CT insertion: Enter pleural space

CT insertion: Palpate pleural space

CT insertion: Insert the tube

CT insertion: Secure the tube

CT insertion: Tape and connect to Pleur-Evac

Needle thoracostomy Used for quick decompression of tension pneumothorax

Airway Management

Airways

Bag-mask ventilation

Nasotracheal Intubation

Endotracheal Intubation

Visualize the Vocal Cords

Cricothyroidotomy

Cricothyroidotomy

Cricothyroidotomy

Cricothyroidotomy

Intravenous Lines -Needle-less system -Prepare tubing, tape, and dressing prior to puncture -Tourniquet placed above vein site

Intravenous Lines

Arterial Punctures/Lines -Punctures made for ABG measurements -Lines indicated for: -unstable B/P -pressor use -critically ill

Arterial Lines -Radial artery is most common site -Check Allen’s test -Positioning is key

Arterial Lines

Arterial Lines

Central Line Insertion -Placed in subclavian, jugular, or femoral vein -Infection rates vary by location of line -Risks include arterial puncture/hematoma, bleeding, pneumothorax, air embolus

Subclavian Line Insertion -Seldinger technique -Trendelenburg -Needle inserted inferior to clavicle -Angle of needle parallel to chest wall -CONTROL WIRE

Internal Jugular Line Insertion

Femoral Vein Line Insertion