1. EMERGENT SURGICAL PROCEDURES Julie Margenthaler, MD

2. Emergent Surgical Procedures

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

4. 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

5. Chest tube placement

6. Steps of CT insertion

7. CT insertion: Positioning/Prepping

8. CT insertion: Local anesthetic

9. CT insertion: Skin incision

10. CT insertion: Enter pleural space

11. CT insertion: Palpate pleural space

12. CT insertion: Insert the tube

13. CT insertion: Secure the tube

14. CT insertion: Tape and connect to Pleur-Evac

15. Needle thoracostomy Used for quick decompression of tension pneumothorax

17. Airway Management

18. Airways

19. Bag-mask ventilation

20. Nasotracheal Intubation

21. Endotracheal Intubation

22. Visualize the Vocal Cords

23. Cricothyroidotomy

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

29. Intravenous Lines

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

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

32. Arterial Lines

35. 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

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

37. Internal Jugular Line Insertion

38. Femoral Vein Line Insertion