REMSTARBC.ca Rural Emergency Medicine Simulation Training and Resource - British Columbia
This page is designed for Family Practice residents starting to work in an ER.
One of the things that became abundantly clear to me some years ago was the students often have grave anxieties about being in an emergency department.
Some of that anxiety can be relieved by making the student completely comfortable in that environment. That means knowing how EVERY piece of equipment works. In other words you need to "Own The Emergency Room".
For rural doctors, this is not just a theoretical idea, as you may be working in a small community on your own, with only 2 or 3 nurses where you alone have to deal with a major trauma or resuscitation.
The following is a list of things you should be VERY familiar with. The plan is for every resident to spend a few hours going through the ER learning each piece of equipment, where things are located and what to do if something doesn't work!
“Own the Emergency Room” - OTER
At the end of this you should know how to do the following:
- Locate Storage Room(s) for extra supplies. Know the key codes if they have them and what is in the room. Spend time poking around.
- Stretcher: Lock/unlock, raise, lower, Trendelenburg, reverse Trendelenburg, raise IV pole, raise/lower railings
- Restraints – locate, know how to do a 4 point restrain on a violent patient.
- Put together a new suction bottle and hook up to wall suction.
- Hook up suction tubing.
- Wall Oxygen
- Take off regulator to attach Ventilator oxygen line.
- Apply nasal prongs to Pt at 3 lpm.
- Bag Valve mask – locate, know how to run 15 lpm.
- EtCO2 – 2 kinds – calorimetric and in line. Know how to hook up to Lifepac, mobile EtCO2 and bedside Monitor.
- Airway cart. Go through all the drawers, familiarize yourself with contents (scopes, blades, cric kit etc).
- RSI drugs – know were Induction drugs and Paralytics are located in the ER.
- Detox kit. Location and contents.
- IV bags
- Spike a bag, flush IV line and connect Y connector to new IV.
- IV pump
- Set up pump for regular IV rates (125 ml/hr), change rate on pump. If you are really good, set up pump for infusion (ie mcg/kg/min)
- IV – know how to use and start a regular IV.
- IV pressor drugs. Know how to mix IV push pressors (Epinephrine and Phenylephrine)
- Pleur-evac- know how to set up/prime with sterile water, connect to wall suction
- Beside Vitals monitor – start, how to stop alarm, connect SpO2 and EtCO2, NIBP manual and auto, set NIBP frequency to q 2, 3, 4 etc minutes.
- Ventilator – set up NIV and Mechanical Vent. Know where circuits, nebulizer attachments, suction tubing attachments and NIV masks are located.
- Ultrasound – how to turn on, change probes. Clean with proper cleaner!
- Tonometer – how to use
- Lifepac – Start, attach leads to patient, set leads on monitor (paddles, lead II etc), attach EtCO2, SpO2, Charge button, Pace button
- Magnifier and Sx glasses. Where they are, how to use.
- IV Drug list.
- IV Infusion charts. Location
- Intraosseous – Sternal and EZ-IO. Location and how to use.
- Cast cart – Location, contents. How to cut and repackage fiberglass. “Casted.ca course’ handout.
- Oxygen tanks. Where they are located. How to attach regulator. Where they attach on the stretchers. How long will the tank last?
- Slit Lamp. Location and how to use it.
- Procedural sedation checklist and RSI checklists. Where to locate. Familiarize yourself with checklists.
- Depending where you end up working, there may be other pieces of equipment you need to learn. Don't be afraid to ask! Nurses are an amazing source of knowledge.
For an MS Word version of this list click HERE.
The link below is to an article in the Canadian Journal of Emergency Medicine in July 2004.
It is an excellent review complied by Canadian Emergency Physicians on how to manage what can often be a chaotic ER setting.