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Emergency Medicine & Trauma

Procedures

Mechanical Ventilation

Mechanical ventilation helps patients who have difficulty breathing on their own. In such instances, the ventilator is connected to the patient via a hollow tube inserted into the patient’s airway. In this way, ventilation is provided – oxygen is supplied and carbon di oxide is removed – until the patient is well enough to be disconnected from the ventilator. It is a boon for patients as the ventilator gives them the time to recover. It should be noted that being on ventilator is not a treatment for the patient’s condition – rather it gives the patient a helping hand while other treatment protocols are carried out.

Advantages of Mechanical Ventilation

  • The patient’s respiratory system gets some rest
  • Gives the patient time to recover
  • Performs the important task of supplying oxygen and removing carbon di oxide

However, there are risks associated with mechanical ventilation and that is the possibility of infection through the tube when the patient is on ventilator for a long time (around 2 weeks). Another risk is the possibility of injury to the lung. In such cases, the patient will be removed from the ventilator and tracheostomy will be done instead.

The duration for which a person is on ventilator will depend purely on the patient’s condition. Some may need it only for a few hours while others may need it for weeks. The patient will not be able to talk or eat normally while on ventilator. However, friends and family need not worry that it will be a painful process for the patient – it does not cause pain but some discomfort because of the tube is expected. Patients on ventilator are usually monitored in the ICU.

Electrocardiogram (ECG)

An electrocardiogram or ECG is one very simple way of checking on the heart’s functioning. During the test, leads are attached to different parts of a patient’s body (chest, arms and legs) and the other end of the leads is connected to the ECG machine. The electrical impulses produced by the heart are then recorded. From the ECG readings, doctors can get an idea of different things:

  • Fast or slow heart beat
  • Stable or irregular heart beat
  • How strong the electrical impulses are

Based on the above, the condition of the heart will be evaluated. The ECG is a very useful tool in emergency situations with treatments being decided based on the ECG result.

An ECG is required in the following scenarios:

  • When a patient is suffering from chest pain
  • A patient complains of breathlessness or has had fainting spells
  • To find out if the patient is suffering from irregular heartbeat
  • After a heart surgery to check on the heart’s functioning
  • To check on the functioning of an implanted pacemaker
  • To check whether medication given for heart conditions has been effective

The procedure itself is painless and gets over quickly. There are hardly any risks associated with it. In some cases, skin irritation at the point where the electrodes made contact with the skin might be experienced.

Arterial Line

An arterial line refers to the hollow tube (catheter) which is inserted into the patient’s artery for reading the patient’s blood pressure. This is more accurate than the readings we get with a BP apparatus and it also allows for continuous monitoring. Usually done for patients in the intensive care unit or ICU, the line is often attached to the patient’s wrist – it can even be connected to the groin or any other artery. An added advantage of arterial line is that blood can be drawn whenever necessary to check the levels of oxygen and carbon di oxide and also for other laboratory test purposes.

When is an arterial line given?

  • Hypertension: When the patient is showing extremely high blood pressure readings and efforts are being made to bring it within control, continuous monitoring of blood pressure becomes a necessity. In such cases an arterial line will be given to monitor the patient’s BP.
  • Hypotension: When the patient is suffering from low BP, IV fluids and sometimes medication will be given to bring the BP back to normal limits. By continuous monitoring of the BP with the help of an arterial line, the IV fluids and medication can be adjusted accordingly.
  • Lung Conditions: When the patient is having respiratory issues, the levels of oxygen and carbon di oxide will have to be continuously monitored. An arterial line eliminates the need for frequent painful drawing of blood by syringe.

When an arterial line is applied, the medical staff will be on the watch-out for blood clots forming, possible infection and bleeding.

Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation or CPR is a life sustaining technique that keeps up the flow of oxygen to the brain and other organs when the patient has suffered a heart attack or has experienced a near drowning incident and the heart has stopped beating. When the heart stops beating the flow of blood and oxygen through the body stops. Organ failure soon follows. If the brain does not get oxygen for 3-4 minutes, it can suffer irreparable damage. By administering CPR, the oxygen delivery to the parts can be continued without interruption till emergency medical help arrives. During CPR, compressions are applied manually in the chest area between the nipples at the rate of 100-120 compressions per minute to maintain blood flow.

CPR normally combines compressions (applied manually to the chest) with mouth-to-mouth breathing. If a person is not trained in CPR even just applying the compressions to the patient can make a huge difference. Starting CPR for a patient has proved life-saving in many scenarios. It is always good to be aware of how to perform CPR – one never knows when it will prove useful.

CPR is applied in the following cases:

  • When a person collapses suddenly
  • He does not seem to be breathing or breathing is limited
  • No pulse is detected

When the patient stirs and shows signs of life CPR can be stopped.

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