RESUS
CENTRAL LINES
PromptList steps in inserting an internal jugular central line
ResponseInformed consent
Aseptic preparation
Head down
Local anaesthetic to site
USS guidance where possible (2016 answer, feel US is standard of care now)
Insert needle to IJV
Pass wire
Dilate vein
Insert central line
Flush all lumens
Secure to skin
Aseptic preparation
Head down
Local anaesthetic to site
USS guidance where possible (2016 answer, feel US is standard of care now)
Insert needle to IJV
Pass wire
Dilate vein
Insert central line
Flush all lumens
Secure to skin
PromptFactors that make inserting a CVC more difficult
Responseinexperienced operator
increasing number of attempts
previous surgery, trauma, radiotherapy
BMI > 30 or < 20
previous catheterisation
children
short neck
increasing number of attempts
previous surgery, trauma, radiotherapy
BMI > 30 or < 20
previous catheterisation
children
short neck
PromptStrategies to minimise complications
ResponseCommence inotropes peripherally whilst awaiting CVC placement
Check coags prior to insertion - Correct coagulopathy (FFP/Cryo/Plt transfusion) prior to line insertion
USS guided - minimise misplacement
Use easily compressible site - femoral vein
Procedure to be done by most experienced operator
Sterile technique - minimise risk of infection
Confirm with CXR prior to use
Check coags prior to insertion - Correct coagulopathy (FFP/Cryo/Plt transfusion) prior to line insertion
USS guided - minimise misplacement
Use easily compressible site - femoral vein
Procedure to be done by most experienced operator
Sterile technique - minimise risk of infection
Confirm with CXR prior to use
PromptIndications for PICC line removal in ED
ResponseClear infection (pus on aspiration, erythema/cellulitis)
PICC line displacement
Leaking or fractured line
PICC cultures positive >2 hours earlier than systemic cultures
Sepsis/shock with suspicion of line infection
PICC line displacement
Leaking or fractured line
PICC cultures positive >2 hours earlier than systemic cultures
Sepsis/shock with suspicion of line infection
PromptFactors that can lead to an elevated CVP
ResponseFluid overload
pregnancy
IPPV
PEEP
vasopressor administration
pulmonary embolism
right ventricular failure
tamponade (may be normal if also hypovolaemic)
tricuspid incompetence
pregnancy
IPPV
PEEP
vasopressor administration
pulmonary embolism
right ventricular failure
tamponade (may be normal if also hypovolaemic)
tricuspid incompetence
PromptULTRASOUND IN RESUS
Response
PromptUltrasound uses in arrest
ResponseCARDIAC - Cardiac Output, and Cardiac Standstill. PEA vs Pseudo PEA vs Cardiac activity
Diagnosis of some of the H’s and T’s:
CARDIAC - Tamponade
LUNGS - Tension Pneumothorax
ABDOMEN - Free Fluid in Abdomen - trauma and AAA
CHEST - Aortic Dissection
CARDIAC/LUNGS - DVT, PE
Guide and assist management
Prognostic uitilty
Efficiency of CPR
Diagnosis of some of the H’s and T’s:
CARDIAC - Tamponade
LUNGS - Tension Pneumothorax
ABDOMEN - Free Fluid in Abdomen - trauma and AAA
CHEST - Aortic Dissection
CARDIAC/LUNGS - DVT, PE
Guide and assist management
Prognostic uitilty
Efficiency of CPR
PromptList sonographic finds for above
Response
Prompt
ResponseA- Diaphragm
B - Liver
C - Kidney
D - Free fluid/blood in morrisons pouch
B - Liver
C - Kidney
D - Free fluid/blood in morrisons pouch