We need to be able to respond instantly to the sickest patients rolling into the resus bay–sometimes with no warning at all.
Philosophy
Instantly Ready
but no need to put things away
EM Docs are good at prep bad at breaking down
Reliability
BVM
from Precision Medical
Airway Cart
Flex Tip Bougie, Intubation Stylet for Hyperangulated Blade
Airway Supplies
Orange Tackle Boxes
Igel 4, Scalpel, Bougie, DuCanto Suction
SCRAM Resus Bag
Suction
Needs to be Set-Up
Intubation Meds
Maryland Boxes
SCRAM Rx Lite
Vascular Access
I/O
Crash Big-Bore
Defib with Pads
Epi
Art Line Set-Up
Trauma
Scalpel
Hemostats
Mayo
Blood
PCC
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We have an anesthesia machine in the trauma room (there’s no EM docs it’s not a thing in Germany just anesthesia and surgery) which is fairly common in Europe (at least In the hospitals I have worked in). I wonder why that isn’t a standard feature in (major) trauma bays in NA ? . Proper capno and expiratory O2 and bagging a patient is way easier than with a BVM and with recirculation and 18 liter flow you can get to 80% EtO2 (there’s the option of 60 liter 02 flush as well) Does not have to be the latest… Read more »
Our Rooms have ETO2 & Capno. Not sure the rationale for why bagging would be easier.
If you have etO2 and capno it’s less of a problem. I’m just used to being able to feel what going on via the bag. And the bvm’s we have are horrible that probably doesn’t help.
Hi! Great post! I’ve worked with both anesthesia machines and bvm in resus, most of the time I use the BVM with a prefitted capno line/EMMA, then switch to transport ventilator after intubation. One great feature of an anesthesia machine, though, is the possibility of sevoflurane inhalation, great for kids and patients with bronchospasm. One thing I find very valuable – is a syringe driver and 50 cc syringes. Norepi should be readily available, along with the rest of emergency drugs. A well drilled team should be able to mix up and start norepi within 90 seconds, bedside, in my… Read more »
Great podcast! Scott do you have a pre primed art-line sitting waiting in your resus room? Specifically – saline up on a pole with a pressure bag, the tubing primed with fluid, and transducer attached. It always seems to take a few minutes for our nurses to get the artline set up. And if they are having to do it during the resuscitation it takes them out of the resus for a that time period. Sometimes we are lucky enough to Get it set up before patient arrival if we have enough notice. I hadn’t thought about it until now… Read more »
we usualy do, but as mentioned, set-up should be instant. Flush with saline at the most distal port, hook up to catheter. Nurses can flush from the top up to the distal port.
Hi Scott, Great podcast – shared it immediately with all my colleagues and residents. At least it’s not only me harping on this stuff, and no one does it better than Scott W. As for the Glidescope versus C-Mac, I have this discussion with our friendly anaesthetist all the time. We now have the Glidescope Core, with hyperangulated, Mac and Miller blades, together with samples of the videoscope. The core also comes with a holder for all the blades and Glidescope stylets, a hook for the videoscopes (to which you could also attach a bougie, though I prefer it in… Read more »
The Glidescope link doesn’t appear (though clicking on my name takes you to the site, whoops!). Alternatively: https://emcrit.org/emcrit/resus-room-readiness/#comment-284822
Great podcast Scott, thank you!
In regards to the comments above. We have ETO2 and Capnography (and studied it). I think there would only be a handful of ED’s that have the ability to measure ETO2 though. I’m not aware of anywhere else in Australia that uses it.
And we definitely don’t have anaesthetic machines in our ED. Would be useful for a bad asthmatic maybe, but can’t see any other real benefit.
Hey there Scott, one idea but I think helps us a lot is that we Create two fully flushed out line set ups in the morning every morning and keep them locked and tackle boxes. We almost never don’t use them and they are just ready to go. If they don’t get used for 24 hours and they are replaced. We also keep basically the “orange tacklebox innovation material” in a lunch tray, that we wrap and a patient belongings back that comes straight out of the cartand can be placed on to a Mayo but doesn’t need to be… Read more »
I work in a local community ED and Level 2 Trauma Center, we see an average volume of 200 patients per day. My question to you is, do you still refrigerate RSI medications and are you stocking them in a locked location within your Resuscitation Room? Additionally what agents do you always have on hand in said storage location. Thanks!
more than pts per day would be intubations/day. From what sounds low volume, would consider chucking a ready-pack of etomidate, roc, epi in a bag not drawn up in a fridge close to resus.
First off – love your podcast and all the blog posts. Thank you to the whole EMCrit project crew. I wonder, especially after this podcast, if your hospital has ED pharmacists? I have only worked at smaller, rural hospitals, so my experience is certainly different from what you often discuss, but we are ALWAYS in the ED for any traumas, intubations, codes, etc (we have ~2 min response time). I would have expected a larger center like you work at to have dedicated pharmacists in-shop all the time, which would eliminate some of the drug readiness concerns. Is that not… Read more »
In this podcast you speak to having the Ambu bag ready, peep valve on, and hooked up to oxygen. At our hospital we are not allowed to do this r/t Jcaho. Is this really a Jcaho issue or just another hospital policy?
who knows? There is actual JC. Then there is the interpretation of the surveyor. Then there is the opinion of the mock surveyor. All of the regs are behind a paywall. Whole system is bullshit. Hook up the BVM to oxygen, put it back in the bag, state it was touched except the O2 tubing. If JC complains it will be a minor, nothing ding. A real hospital will put their pts before caring about silliness like this. The resus bays need a set-up suction and a set-up BVM.