The Procedures Course Podcast

Prehospital limb amputation is an uncommonly performed procedure whereby amputation of an entrapped limb is required to facilitate the safe extrication of a patient in a life-threatening situation.

Resuscitative hysterotomy is the emergent delivery of a foetus from a mother in cardiac arrest to improve the outcomes of both the mother and foetus. Questions covered include: * Is the 4 minute rule really valid? * What are the technical steps in performing the procedure?

Most fatalities from blunt or penetrating cardiac injuries occur prior to hospital arrival. The main reversible pathology is acute cardiac tamponade, which may be present without external signs of injury, abnormal clinical signs, or ECG abnormalities. The cause of the tamponade is usually a laceration to a low-pressure cardiac cavity. In recent years the widespread use of ultrasound in the initial assessment of severely injured patients has facilitated the early diagnosis of cardiac tamponade and associated cardiac injuries.

Escharotomy involves incision of inelastic burned tissue (eschar) that can impair perfusion of the extremities, as well as restrict chest wall movement and ventilation. Indications: * Limb hypoperfusion * Ventilation restriction Limb Hypoperfusion Can occur with circumferential AND non-circumferential burns.

Lateral canthotomy (incision of lateral canthus) and cantholysis (cutting of the inferior canthal tendon) are stepwise sight saving procedures performed in the setting of acute orbital compartment syndrome. This most commonly occurs with a traumatic retro-bulbar haematoma. Although the incidence of retro-bulbar haemorrhage is rare, delay in intervention can lead to visual loss.

Temporary transvenous cardiac pacing involves insertion of a pacing wire (catheter based electrode) into the right ventricle to allow electrical stimulation of the myocardium. Transvenous pacing is usually attempted in the emergency department after less invasive treatments have been unsuccessful.

The anatomical properties of the subclavian vein provide a number of benefits for its use in central venous access, especially during trauma resuscitation. The subclavian vein is a large diameter central vein without valves which, as a result of its soft tissue attachments, remains patulous and undisplaced even in the hypovolaemic patient.

Pleural decompression with subsequent tube thoracostomy is one of the most commonly performed life-saving procedures for traumatic chest injuries. Thoracic injuries are primarily responsible for 25% of all trauma deaths and contribute to a further 25% of deaths. However, over 85% of patients with thoracic trauma do not require thoracic surgery.

An emergency surgical airway may be a life-saving procedure in situations where other airway management techniques have failed or are contraindicated. Whilst the incidence of the can’t intubate, can’t oxygenate (CICO) scenario is low, with estimates ranging from 1/50,000 intubations in the operating theatre to 1/100 intubations in the Emergency Department, being able to gain access to the airway via the anterior neck is an essential rescue option.