Transfusion of blood components (red cells, white cells, platelets, whole plasma, or plasma fractions) is commonplace in the emergency department (ED). Annually in the United States, 15 million blood donations take place and 14 million units of red blood cells…
Introduction Autologous blood transfusion, or autotransfusion, is the collection and reinfusion of a patient's own blood for volume replacement. Preoperative blood banking and intraoperative cell salvage techniques have increased in a multitude of surgical specialties. Autotransfusion in the emergency department…
The rapid administration of lifesaving, pain-relieving, and sedative medications lies at the core of the practice of emergency medicine. The intravenous (IV) route is usually the delivery method of choice. However, there are circumstances in which vascular access is either…
Establishing vascular access in critically ill and injured patients is central to the practice of emergency medicine. Moreover, placing an intravenous (IV) catheter in an acutely ill child can be one of the most challenging and frustrating procedures that a…
Indwelling vascular access devices (IVADs) provide routes for short- and long-term infusion of antibiotics, antifungal agents, hyperalimentation fluids, chemotherapeutic agents, blood products, analgesics, and anesthetic agents. In addition, they provide access for lifesaving procedures such as hemodialysis (HD) and plasmapheresis.…
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 Venous cutdown, a time-honored surgical technique, has largely been replaced by alternative…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…