Section: Module 4: Common Emergency Procedures | Didactic Emergency Medicine | NextGenU.org

  • Competencies covered in this module:
    • Perform the procedures listed in the Data supplement S2 of the Emergency Medicine Clerkship Curriculum. In addition to proper technique, the focus should be given to recognizing the indications, contraindications, and complications associated with each. The student should be able to discuss aftercare and reasons to return for further evaluation with the patient.
    • Emergency medicine is a very hands-on specialty and practitioners must be competent in a variety of procedures. As a medical student, you are not expected to be able to perform all of these procedures, but should be familiar with the indications and understand how each procedure is performed. The material here will guide you through common procedures, but you should gain as much hands-on experience as possible with your supervisor.

    • Module 4: Lesson 1: Access
       
      Student Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • Demonstrate placement of an intravenous line.
      • Demonstrate basic phlebotomy technique.
      • List the indications for an intraosseous line.
      • Describe intraosseous insertion technique.
      • List the indications and complications of a central line.
      • List the steps for the Seldinger technique.
      • Describe relative advantages and disadvantages of different kinds of lines.

      Approximate time required to complete the readings (at 144 words/minute) and assignments for this module: 163 minutes.

       
      Required Learning Resources and Activities
    • Go through this entire module

    • Ask your supervisor to review the materials related to the insertion of an intravenous catheter along with any institutional specific policies and procedures with you and guide you in the practice of establishing intravenous access. 

      Click on the submit button and write one sentence that indicates you have performed this activity. If for some reason you cannot perform the activity, please indicate that and the reason why you were unable to perform the activity. Your mentor will grade your activity pass/fail.

    • quiz icon
      Quiz: Module 4: Lesson 1: IV Access

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 1/1.

    • Have you ever had a patient become frustrated with an unsuccessful attempt to insert an IV? Describe this experience. Do not use any identifying information.

    • Review only the sections regarding intraosseous access. 

    • quiz icon
      Quiz: Module 4: Lesson 1: Intraosseous Access

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 2/3.

      Not available unless: The activity Quiz: Module 4: Lesson 1: IV Access is complete and passed
    • Read the checklist

    • Read the entire text

    • quiz icon
      Quiz: Module 4: Lesson 1: Central Line Insertion

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 2/2.

    • Ask your supervisor to review the materials related to the insertion of a central venous catheter along with any institutional specific policies and procedures with you and guide you in the practice of the insertion of a central venous line. 

      Click on the submit button and write one sentence that indicates you have performed this activity. If for some reason you cannot perform the activity, please indicate that and the reason why you were unable to perform the activity. Your mentor will grade your activity on a pass/fail basis.

    • If you had to give three pieces of advice to a student about central line insertion, what would you say?

    • Module 4: Lesson 2: Airway Management 
       
      Student Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • List the indications for emergency airway management.
      • Demonstrate effective ventilation.
      • List the factors that can make BVM difficult or impossible.
      • Describe the roles and indications for various airway adjuncts.
      • Demonstrate correct placement of a nasal and oral pharyngeal airway.
      • List the indications for endotracheal intubation.
      • D List the steps in orotracheal intubation.
      • Describe possible complications of intubation.
      • Describe situations when rescue techniques may be used in a failed airway.

      Approximate time required to complete the readings (at 144 words/minute) and assignments for this module: 163 minutes.

       
      Required Learning Resources and Activities
    • Review Table 1

    • quiz icon
      Quiz: Module 4: Lesson 2: Airway Establishment and Control

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 1/1.

    • What are three key pieces of advice that you wish the general public would know about the Heimlich maneuver?

    • Go through this entire module

    • quiz icon
      Quiz: Module 4: Lesson 2: Basic Airway Management

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF1/1.

    • Name three possible negative consequences the patient may face if airway management fails to precede all other treatments.

    • Ask your supervisor to review the institutional specific policies and procedures for bag-mask ventilation with you along with the proper positioning of the patient. Ask him/ her to guide you in the practice of ventilating a patient using this method and practice this skill until you are comfortable. 

      Click on the submit button and write one sentence that indicates you have performed this activity. If for some reason you cannot perform the activity, please indicate that and the reason why you were unable to perform the activity. Your mentor will grade your activity on a pass/fail basis.

    • Please click the link provided and review the entire page.

    • Please watch the entire video.

    • Please watch the entire video.

    • quiz icon
      Quiz: Module 4: Lesson 2: Airway Management

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 2/3.

    • Ask your supervisor to review the materials related to the insertion of airway adjuncts along with any institutional specific policies and procedures with you and guide you in the practice of the insertion of airway adjuncts.

      Click on the submit button and write one sentence that indicates you have performed this activity. If for some reason you cannot perform the activity, please indicate that and the reason why you were unable to perform the activity. Your mentor will grade your activity on a pass/fail basis.

    • Go through this entire module

    • quiz icon
      Quiz: Module 4: Lesson 2: Advanced Airway Management

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 2/3.

    • Describe the correct head and neck position for airway management, and why this position is important.

    • Module 4: Lesson 3: Arrhythmia Management
       
      Student Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • Correctly place the patient on a cardiac monitor.
      • Demonstrate the ability to apply leads and obtain a 12-lead electrocardiogram.
      • Demonstrate appropriate use of an AED.
      • Recognize ventricular fibrillation and pulseless ventricular tachycardia.
      • Demonstrate appropriate use of a defibrillator.
      • Demonstrate effective chest compressions.

      Approximate time required to complete the readings (at 144 words/minute) and assignments for this module: 274 minutes.

       
      Required Learning Resources and Activities
    • Review the chart for cardiac monitoring lead placement

    • Read the entire text

    • Go through this entire module

    • quiz icon
      Quiz: Module 4: Lesson 3: Cardiac Monitoring

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 3/4.

    • Ask your supervisor review and demonstrate the application of a 12 lead cardiac monitor to obtain an EKG with you, including institutional policy and procedure. Ask him/ her to guide you in the application of the monitor. 

      Click on the submit button and write one sentence that indicates you have performed this activity. If for some reason you cannot perform the activity, please indicate that and the reason why you were unable to perform the activity. Your mentor will grade your activity on a pass/fail basis.

    • Describe two ways in which supraventricular tachycardia can be distinguished from ventricular tachycardia.

    • What are the biggest challenges or difficulties you've had in learning to interpret ECGs?

    • Ask your supervisor to review and demonstrate the application and use of an AED with you, including institutional policy and procedure. Ask him/ her to guide you in the application and use of an AED.

      Click on the submit button and write one sentence that indicates you have performed this activity. If for some reason you cannot perform the activity, please indicate that and the reason why you were unable to perform the activity. Your mentor will grade your activity on a pass/fail basis.

    • How common are AEDs outside of your hospital (e.g., are they commonly available in airports, casinos, or in private residences)?

    • Read the entire text

    • Read the entire text

    • Ask your mentor to review the operation of the defibrillator available at your institution with you along with along any relevant institutional specific policies and procedures. Ask him/ her to guide you in the use of the defibrillator.

      Click on the submit button and write one sentence that indicates you have performed this activity. If for some reason you cannot perform the activity, please indicate that and the reason why you were unable to perform the activity. Your mentor will grade your activity on a pass/fail basis.

    • quiz icon
      Quiz: Module 4: Lesson 3: Defibrillator

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 1/1.

    • Read the webpage to learn how to perform chest compressions.

      For supplemental learning, view the image.


    • quiz icon
      Quiz: Module 4: Lesson 3: CPR

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 1/1.

      Not available unless: The activity Quiz: Module 4: Lesson 3: Defibrillator is complete and passed
    • Ask your supervisor to review, demonstrate and guide you in the performance of chest compressions.

      Click on the submit button and write one sentence that indicates you have performed this activity. If for some reason you cannot perform the activity, please indicate that and the reason why you were unable to perform the activity. Your mentor will grade your activity on a pass/fail basis.

    • Have you ever had to perform CPR in a situation outside of your ED or other medical setting? If so, describe this experience without using any identifying information.

    • Additional Learning Options
    • Module 4: Lesson 4: Nasogastric Intubation
       
      Student Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • List the indications for placement of a nasogastric tube.
      • Describe the proper technique for insertion of a nasogastric tube.
      • Describe complications of nasogastric tube placement.

      Approximate time required to complete the readings (at 144 words/minute) and assignments for this module: 10 minutes.

       
      Required Learning Resources and Activities
    • Read the entire text

    • quiz icon
      Quiz: Module 4: Lesson 4

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 1/1.

      Not available unless: The activity Quiz: Module 4: Lesson 3: CPR is complete and passed
    • What can you do to relieve a patient's discomfort when inserting a nasogastric tube?

    • Module 4: Lesson 5: GU Catheterization
       
      Student Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • Demonstrate the correct placement of a Foley (male and female) catheter.

      Approximate time required to complete the readings (at 144 words/minute) and assignments for this module: 78 minutes.

       
      Required Learning Resources and Activities
    • Go through the entire module

    • Ask your supervisor to review the materials related to the insertion of urinary catheters along with any institutional specific policies and procedures with you and guide you in the practice of the insertion of a urinary catheter.

      Click on the submit button and write one sentence that indicates you have performed this activity. If for some reason you cannot perform the activity, please indicate that and the reason why you were unable to perform the activity. Your mentor will grade your activity on a pass/fail basis.

    • quiz icon
      Quiz: Module 4: Lesson 5

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 1/1.

      Not available unless: The activity Quiz: Module 4: Lesson 4 is complete and passed
    • What can the physician do to reduce some of the risks associated with catheterization?

    • Module 4: Lesson 6: Orthopedic
       
      Student Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • List the indications for emergency joint reduction.
      • Describe the initial assessment of a suspected dislocated joint.
      • List several types of extremity splints and their indications.
      • Demonstrate the correct application of a splint.
      • Describe complications associated with splints.

      Approximate time required to complete the readings (at 144 words/minute) and assignments for this module: 94 minutes.

       
      Required Learning Resources and Activities
    • Read the entire text

    • Read the entire text

    • quiz icon
      Quiz: Module 4: Lesson 6: Dislocations

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 2/3.

      Not available unless: The activity Quiz: Module 4: Lesson 5 is complete and passed
    • Go through the module up to Step 10

    • Ask your supervisor to review and demonstrate casting/splinting principles with you, including institutional policies and procedures. Ask him/ her to guide you in the application of a splint. 

      Click on the submit button and write one sentence that indicates you have performed this activity. If for some reason you cannot perform the activity, please indicate that and the reason why you were unable to perform the activity. Your mentor will grade your activity on a pass/fail basis.

    • What are some of the greatest challenges about applying a cast on young children?

    • Additional Learning Options
    • Module 4: Lesson 7: Infection: Incision and Drainage
       
      Student Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • List the indications for an incision and drainage.
      • Discuss the technique for an incision and drainage.
      • List the indications for antibiotic therapy for an abscess/cellulitis.
      • Describe complications of incision and drainage.

      Approximate time required to complete the readings (at 144 words/minute) and assignments for this module: 20 minutes.

       
      Required Learning Resources and Activities
    • Read the entire text

    • quiz icon
      Quiz: Module 4: Lesson 7

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 3/4.

      Not available unless: The activity Quiz: Module 4: Lesson 6: Dislocations is complete and passed
    • Module 4: Lesson 8: Trauma Management
       
      Student Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • List the steps of primary survey in trauma.
      • Demonstrate maintenance of C-spine stabilization.
      • List the components of a FAST ultrasound examination.
      • Recognize an abnormal FAST ultrasound examination.

      Approximate time required to complete the readings (at 144 words/minute) and assignments for this module: 145 minutes.

       
      Required Learning Resources and Activities
    • Read the section on primary survey

    • quiz icon
      Quiz: Module 4: Lesson 8: Trauma

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 2/3.

      Not available unless: The activity Quiz: Module 4: Lesson 7 is complete and passed
    • Describe why the pelvis is an important area to assess during a primary survey in trauma.

    • Read the entire article

    • Ask your supervisor to demonstrate and guide you through proper C-spine immobilization, including institutional policy and procedure. 

      Click on the submit button and write one sentence that indicates you have performed this activity. If for some reason you cannot perform the activity, please indicate that and the reason why you were unable to perform the activity. Your mentor will grade your activity on a pass/fail basis.

    • There is a misconception that applying a cervical collar protects the patient's entire spinal cord. Explain where this misconception comes from, and whether it persists in your ED today.

    • Read pages 1 to 5 only

    • quiz icon
      Quiz: Module 4: Lesson 8: Abdominal Trauma

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 2/3.

      Not available unless: The activity Quiz: Module 4: Lesson 8: Trauma is complete and passed
    • Is ultrasound available in your ED?

      If so, in what ways does it help you to evaluate abdominal trauma?

      If not, how does it hinder your ability to evaluate abdominal trauma?

    • Module 4: Lesson 9: Wound Care
       
      Student Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • List the factors that go into the decision to close a wound primarily.
      • Describe the difference between a clean and dirty wound.
      • Explain local and regional (digital) anesthetic techniques.
      • Describe the maximum doses of lidocaine.
      • Demonstrate the application of local anesthesia.
      • Describe the role or sterility in wound irrigation and repair.
      • Explain proper irrigation technique.
      • Describe how to detect a retained foreign body.
      • Describe different closure techniques (Steri-strips, Dermabond, suturing).
      • List the various suture materials and their appropriate uses.
      • Demonstrate proper closure of a wound (simple interrupted technique).
      • Describe the number of days for suture removal.
      • List the indications for tetanus prophylaxis.

      Approximate time required to complete the readings (at 144 words/minute) and assignments for this module: 144 minutes.

       
      Required Learning Resources and Activities
    • Read this section only

    • quiz icon
      Quiz: Module 4: Lesson 9: Preparation

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 1/1.

      Not available unless: The activity Quiz: Module 4: Lesson 8: Abdominal Trauma is complete and passed
    • How common is tetanus prophylaxis in your country/region? What is the impact of tetanus in your area of the world?

    • Read the section on local anesthetics and local infiltration

    • quiz icon
      Quiz: Module 4: Lesson 9: Anesthesia

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 2/3.

      Not available unless: The activity Quiz: Module 4: Lesson 9: Preparation is complete and passed
    • Ask your supervisor to review, demonstrate and guide you in the performance of local anesthetic infiltration administration, including institutional policy and procedure. 

      Click on the submit button and write one sentence that indicates you have performed this activity. If for some reason you cannot perform the activity, please indicate that and the reason why you were unable to perform the activity. Your mentor will grade your activity on a pass/fail basis.

    • What are some of the greatest challenges in learning how to properly perform local anesthetic infiltration?

    • Read the section Investigating for Possible Foreign Body

    • quiz icon
      Quiz: Module 4: Lesson 9: Wound Management

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 2/3.

      Not available unless: The activity Quiz: Module 4: Lesson 9: Anesthesia is complete and passed
    • Describe sterile technique, and what could happen if the physician fails to follow sterile technique.

    • What are some of the risks associated with not examining a wound due to a foreign body within 24 hrs?

    • Go through the rest of this module, reading the text and watching the videos.  Note:  Parts of this module were already read ("Wound considerations" and "Wound antisepsis and sterile technique").

    • Read the section on suture removal

    • Ask your supervisor to review, demonstrate and guide you in the practice of suture placement, including institutional policy and procedure. 

      Click on the submit button and write one sentence that indicates you have performed this activity. If for some reason you cannot perform the activity, please indicate that and the reason why you were unable to perform the activity. Your mentor will grade your activity on a pass/fail basis.

    • How can a co-existing illness like diabetes affect healing times?