Patients with implanted pacemakers or automatic implantable cardioverter defibrillators (AICDs) are commonly seen in the emergency department (ED). Fortunately, the increased reliability of these devices has precluded a marked increase in patients with true emergencies related to device malfunction, but…
Introduction Defibrillation is an emergency procedure performed to terminate ventricular fibrillation (VF) ( Fig. 12.1 A ). VF is a potentially lethal, but survivable, rhythm commonly found in victims of sudden cardiac arrest (SCA). VF can be caused by myocardial…
Introduction Patients in the emergency department frequently complain of palpitations, heart fluttering, or a rapid heartbeat, which is often coupled with weakness, chest pain, or dizziness. The physician must determine the exact rate, rhythm, origin, and cause of the tachycardia…
Tube thoracostomy is a procedure used to evacuate an abnormal accumulation of fluid or air from the pleural space and can be performed on an elective, urgent, or emergent basis. Air or fluid can accumulate in the pleural space as…
Thoracentesis is a percutaneous procedure during which a needle is inserted into the pleural space to remove fluid for diagnostic or therapeutic purposes. When performed using real-time ultrasound (US) guidance, thoracentesis has an extremely low rate of complications. Anatomy The…
Introduction Mechanical ventilation (MV) is an important tool for resuscitation of critically ill patients in the emergency department (ED). It is vital that ED practitioners have a thorough understanding of the basics of MV and to know when to apply…
Introduction Placement of a tracheostomy tube is a common procedure in critically ill patients. Common indications for this procedure include upper airway obstruction, head or neck trauma, and prolonged respiratory failure. Approximately one fourth of patients in the intensive care…
Few clinical scenarios are as critical as when a patient's airway cannot be controlled with traditional endotracheal (ET) intubation. Although cricothyrotomy is rarely required, the incidence of surgical airways has decreased even further since the advent of adjunctive intubation techniques.…
Endotracheal (ET) intubation in the emergency setting presents a challenge distinct from that associated with intubation of fasted, premedicated patients in the operating room (OR). Patients in the emergency department (ED) are frequently uncooperative and unstable and may have medical…
Intubation is often the pivotal procedure in the emergency management of critically ill patients. There are several new devices that can improve the likelihood of successful intubation, and it is important to put the intubation procedure in perspective, understanding that…