Cardiothoracic

Rapid Review

• Background
  • Insertion of a chest tube into the pleural cavity to drain blood, air, bile, pus, or other fluids. Allows for continuous, large volume drainage compared to needle thoracostomy.
• Indications
  • Hemothorax, pneumothorax, empyema, pleural effusion
• Contraindications
  • No absolute contraindication. Relative contraindications include coagulopathy, overlying skin infection, and pulmonary/pleural adhesions.
• Complications
  • Misplaced tube (kinked or too deep), infection, damage to nerves/vessels. 

Pearls

Deep Dive

• Cutting Through the Triangle: A Review of Tube Thoracostomy in the ED

Rapid Review

Pearls

Deep Dive

Rapid Review

• Background
  • Insertion of a needle (typically 14 gauge) into the pleural space to decompress tension pneumothorax. Typically inserted in the 2nd intercostal space (above the 3rd rib) in the midclavicular line, or the 4th/5th intercostal space in the anterior axillary line.
• Indications
  • Suspected tension pneumothorax (progress shortness of breath, asymmetric lung sounds, tracheal deviation, jugular venous distension, hypotension)
• Contraindications
  • No absolute contraindications
• Complications
  • Lung laceration, kinking of catheter, dislodgement

Pearls

Deep Dive

• How To Do Needle Thoracostomy (Merck Manual)

Rapid Review

Pearls

Deep Dive

Rapid Review

Pearls

Deep Dive

Rapid Review

• Background
  • Defibrillation that is synced to the R or S wave of the QRS complex to avoid energy delivery near the apex of the T wave, which is a vulnerable period for induction of ventricular fibrillation. 
• Indications
  • SVT, atrial tachycardia, new-onset (or unstable) atrial fibrillation
• Contraindications
  • Rhythms requiring unsynchronized defibrillation (pulseless V-tach, V-fib). Caution using for A-fib in patients not anticoagulated (risk of stroke)
• Complications
  • Severe bradycardia/asystole. Burns.

Pearls

Deep Dive

• Electrical Cardioversion in the ED: Who Crashes and How to Improve (emDOCs)

Rapid Review

• Background
  • Temporary, non-invasive means of providing ventricular stimulation to the patient’s heart using pads 
• Indications
  • Symptomatic bradyarrhythmias (AV blocks, sinus node dysfunction, malfunction of implanted pacemaker, etc.)
• Contraindications
  • Stable, asymptomatic patients. Bradyarrythmias secondary to hypothermia. 
• Complications
  • Failure to capture, pain/discomfort, skin burns.

Pearls

Deep Dive

• Transcutaneous Pacing (Downeast Emergency Medicine)

Rapid Review

Pearls

Deep Dive

Rapid Review

• Background
  • Procedure performed to remove fluid from the pleural space for both diagnostic and/or therapeutic purposes. 
• Indications
  • pleural effusion
• Contraindications
  • No absolute contraindications; relative contraindications include coagulopathy or inability to place patient in a safe position.
• Complications
  • Pneumothorax, cough, infection, re-expansion pulmonary edema.

Pearls

Deep Dive

• Considerations When Performing ED Thoracentesis (EMRA)

Rapid Review

Pearls

Deep Dive