Most of us were taught to place central lines using the wire through needle Seldinger technique, but using the introduction catheter instead of the needle makes successful wire insertion more likely and facilitates venous confirmation. A 7 minute screencast. on vimeo operating room video of wire through catheter technique. recommend viewing at 2x speed. Update 1 Lee 2015 compares wire through needle and wire through catheter and shows that wire through needle is (slightly) better. The operators were anesthesiologists very experienced in central line insertion, which may account for their results. In the less controlled ED environment, with providers who don’t place a lot of lines (especially learners), the tendency of the needle to move before the wire can be transmitted may be more important. Also they did not confirm venous location in this study, which should be done whenever feasible and is greatly facilitated by the wire through catheter technique. Still, I’m aware of no data comparing the two techniques other than this (which appeared a few weeks after I posted the video), so though my success rate is definitely higher since I switched to wire through catheter, your mileage may vary. Update 2 There are two advantages of the wire through needle (conventional approach): the needle is functionally slightly longer than the catheter, and the needle doesn’t kink. Neither of these advantages make a difference at the IJ site, and where I work almost all lines are IJ, so I didn’t mention this in the video. Based on feedback, I am surprised (and pleased) at how many non-IJ lines are…
by reuben in _lecture, vascular access
Audio Slides References
Ten minute screencast describing an expanded ABCs mnemonic. Mobile phone optimized cheat sheet at emupdates.com/resus. Slides. Audio. Resus Room pic.
by reuben in _lecture, PSA & analgesia
Three part screencast covering the essentials of procedural sedation and analgesia for emergency clinicians. Part one covers how to think about and prepare for PSA, including a discussion of fasting guidelines. 13 minutes. Part two describes how patients are harmed during PSA and how to prevent patients from being harmed during PSA. 29 minutes. Part three discusses contemporary PSA pharmacology. 16 minutes. References Slideset Emergency Department PSA Checklist
Ventilation is the most important skill in airway management, and most of us learned to do it incorrectly. Slideset. As given at Emcrit’s critical care conference.
by reuben in _lecture, airway, kids
slideset available here.
by reuben in _lecture, heuristic
30 minute presentation on optimal patient assessment in the emergency department. garbled audio resolves at the one minute mark. Slides and Handout. More recent live version. EM Thinking in Polish (credit: Janusz Springer)
by reuben in _lecture, airway
high-def vimo screencast here. slideset here. audio here.
by reuben in _lecture, airway
For 8 minute Pecha Kucha competition at Scott Weingart’s ED Critical Care Conference, January 13 2010.