04 Jan 09

Lumbar puncture

Posted in Procedure videos at 0:00 by Laci

By MS Ellenby, K Tegtmeyer, S Lai and DAV Braner

NEJM 2006;355:e12

This video will demonstrate safe and successful methods of performing lumbar puncture. Lumbar puncture is indicated for both diagnostic and therapeutic purposes. Also, the administration of spinal and epidural anesthesia involves the use essentially of the same technique.

Analysis of cerebrospinal fluid may be helpful in the diagnosis of infectious processes such as meningitis, inflammatory diseases such as multiple sclerosis, cancers such as leukemia, and metabolic processes. Therapeutically, lumbar puncture allows for the intrathecal administration of chemotherapeutic agents and antibiotics. There are specific contraindications to lumbar puncture. The condition of patients with cardiorespiratory compromise may worsen as a consequence of . . . .

14 Dec 08

Cricothyroidotomy

Posted in Procedure videos at 0:00 by Laci

By J Hsiao and V Pacheco-Fowler

NEJM 2008;358:e25

Cricothyroidotomy is an emergent procedure performed on patients experiencing severe respiratory distress in whom orotracheal or nasotracheal intubation has failed. The procedure involves making an incision in the cricothyroid membrane, which lies between the thyroid and

cricoid cartilages, followed by inserting a tracheostomy tube, which allows ventilation. This video describes how to perform a cricothyroidotomy in an adult. The major indication for cricothyroidotomy is the inability to establish an airway by orotracheal or nasotracheal intubation. Failure to secure an orotracheal or nasotracheal airway may be due to factors such as difficult patient anatomy; excessive blood in the mouth or . . . .

04 Dec 08

Central venous catheterization — Subclavian vein

Posted in Procedure videos at 0:00 by Laci

By DAV Braner, S Lai, S Eman and K Tegtmeyer

NEJM 2007;357:e26

Evidence suggests that the risk of major central venous line complications, particularly line-related bloodstream infections, is lower when the subclavian approach is used. This video will identify the landmarks and procedure for placement of a subclavian central line.

Specific contraindications for the placement of a central venous line in the subclavian vein include infection of the area overlying the target vein and thrombosis of the target vein and fracture or suspected fracture of the clavicle or proximal ribs. Coagulopathy, while not an absolute contraindication, should be of greater concern with the subclavian approach because of the difficulty in applying . . . .

21 Nov 08

Placement of an arterial line

Posted in Procedure videos at 0:00 by Laci

By K Tegtmeyer, G Brady, S Lai, R Hodo and D Braner

NEJM 2008;358:e30

This video will demonstrate arterial line placement in the radial artery using two of the many techniques available for arterial line placement, an over-the-wire technique and an over-the-needle technique. Placement of an arterial line is indicated for continuous monitoring of arterial pressure and direct arterial blood sampling.

The radial pulse is palpated between the distal radius and the flexor carpi radialis tendon. Prior to line placement, perfusion of the extremity should be checked. For radial arterial catheters, an Allen test or a modified Allen test may be performed. While the value of the Allen test has . . . .

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