Management of critically ill or injured patients requires immediate and adequate vascular access, especially during trauma resuscitation, when rapid infusion of crystalloid or blood products may be necessary. Venous cutdown, a time-honored surgical technique, has largely been replaced by alternative…
Central venous access remains a cornerstone of resuscitation and critical care in both the emergency department (ED) and intensive care unit. Advanced hemodynamic monitoring, rapid infusion of fluid, placement of transvenous pacemakers, and administration of selected medications all require reliable…
Introduction Intravenous (IV) access is a mainstay of modern medicine. IV cannulation is a procedure ( Videos 21.1 and 21.2 ) performed by a wide array of health care professionals, including physicians, nurses, physician assistants, phlebotomists, and emergency medical technicians.…
Arterial puncture is the most accurate blood sampling technique for true arterial blood gas (ABG) and acid-base determination. The absence of arterial blood pressure defines cardiac arrest and serves as a definitive end point for resuscitative efforts. Intraarterial cannulation with…
Obtaining vascular access and blood samples in an infant or child can challenge and frustrate even the most skilled emergency clinician and can be especially challenging in children who are dehydrated or in shock. Resuscitation of critically ill and injured…
In the United States trauma is the leading cause of death in people aged 1 through 44. Blunt trauma accounts for the majority of trauma mortality overall, but in urban settings penetrating trauma, including firearm-related injuries, accounts for an increased…
Cardiopulmonary resuscitation (CPR) can be lifesaving for a patient in cardiac arrest, particularly in conjunction with other therapies such as defibrillation or delivery of medications. In several large clinical studies, data have shown that prompt delivery of CPR serves as…
Definition Pericardial effusion, the presence of fluid within the pericardial space, has a number of causes. As fluid accumulates, a critical point is reached at which pericardial pressure negatively affects cardiac filling and causes circulatory insufficiency. This is called pericardial…
The purpose of cardiac pacing is to restore or ensure effective cardiac depolarization. Emergency cardiac pacing may be instituted either prophylactically or therapeutically. Prophylactic indications include patients with a high risk for atrioventricular (AV) block. Therapeutic indications include symptomatic bradyarrhythmias…
Introduction The electrocardiogram (ECG) is a graphic recording of the electrical activity of the heart. The standard ECG is obtained by applying electrodes over the chest and limbs to record the electrical activity of the cardiac cycle. Developed over 100…