• Approach
  • Position the probe over posterior aspect of affected shoulder with indicator to patient’s left
  • Measure distance between glenoid and humeral head
• Advantages: faster than XR, ~100% sensitivity
• Disadvantages: less sensitive for fractures, operator dependent, not full agreement on measurements

Fascia iliaca compartment block (FICB)

• This is different from the “femoral nerve block” and “3 in 1 block”
  • FICB anesthetizes femoral nerve and lateral femoral cutaneous nerve
• Target: facial plane above the iliacus muscle. Infrainguinal.
• Inject 30-40 mL medial to femoral nerve using a 21 or 20 gauge spinal needle and extension tubing
• 0.2% or 0.5% Ropivacaine or Bupivacaine
  • Analgesia onset within 30 min and lasts ~12 hrs
  • If using 0.5% dilute 20 mL anesthesia with 20 mL NS
  • ALWAYS calculate your dose

PE Clinical Pathway

• Categorization
  • Massive: hypotension
  • Submassive: RV dysfunction or myocardial necrosis w/o hypotension
  • Non-massive or Sub-segmental: no hypotension, RV dysfunction, myocardial necrosis
• Utilize PERC and Wells criteria
• See full pathway posted separately

Extremity Trauma by Dr. Caleb Davis

• Clavicle fx – typically manage with sling
  • May need OR if there is skin tenting or blanching
• Beware of scapulothoracic dissociation in AC joint injury. Requires OR
• Luxatio erecta (inferior dislocation) – to reduce, push the humeral head anteriorly under traction and then reduce like an anterior dislocation
• Scaphoid fracture – MRI is best imaging modality in the acute setting
• Pelvic ring injuries a thorough rectal and vaginal exam is indicated to rule out hollow viscus injury from the bone.
• Hip dislocation – need post-reduction pelvic CT to look for fracture fragments
• Femoral shaft fractures
  • associated injuries common
  • Need to make sure patient is adequately resusicated prior to operation to avoid 2nd hit injury to lungs. Get lactic and ABG to measure resus. Place on 2L NC.
  • Don’t miss open fractures. Can be small “poke-hole”
• Knee dislocations – get ABG and CTA
• Tibial plateau fractures are often too swollen to fix initially.
• Fractures 2/2 GSW from 9mm rounds or lower are not considered open fractures
• Compartment syndromes
  • pain out of proportion (first symptom)
  • pain with passive stretch (most sensitive finding)
  • Clinical diagnosis

Airway Assessment and Interventions

• Sedation/RSI
  • Depth of sedation: mild, moderate, deep, general anesthesia
  • Risk assessment with ASA class and LEMON
  • SOAP-ME
    • Suction
    • Oxygen- preoxygenation and apneic oxygenation
    • Airway equipment
    • Positioning – put the towel roll under the occiput (NOT the shoulder) to align the tragus and sternal notch. Consider ramping the patient.
    • Meds
    • Equipment/EtCo2