preparing for office emergencies ocfp scientific meetings november 29, 2013 l. malo md, ccfp(em),...
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Preparing for Office Emergencies
Preparing for Office Emergencies
OCFP Scientific Meetings
November 29, 2013
L. Malo MD, CCFP(EM), FCFP
OCFP Scientific Meetings
November 29, 2013
L. Malo MD, CCFP(EM), FCFP
Faculty / Presenter DisclosureFaculty / Presenter Disclosure
Faculty: Dr. Larry Malo Program: 51st Annual Scientific
Assembly
Relationships with commercial interests:
NONE
Faculty: Dr. Larry Malo Program: 51st Annual Scientific
Assembly
Relationships with commercial interests:
NONE
Disclosure of Commercial Support
Disclosure of Commercial Support
This program has NOT received any financial support
This program has NOT received in-kind support
Potential for conflict of interest: Illustrative photographs may identify
a particular brand or product in a market where others may exist.
This program has NOT received any financial support
This program has NOT received in-kind support
Potential for conflict of interest: Illustrative photographs may identify
a particular brand or product in a market where others may exist.
Mitigating Potential BiasMitigating Potential Bias
Wherever slides depict a commercially available product, this will be explicitly identified and the participants will be made aware that the product may be available from other manufacturers
Wherever slides depict a commercially available product, this will be explicitly identified and the participants will be made aware that the product may be available from other manufacturers
Preparing for Office emergenciesPart I
Are you ready???
Preparing for Office emergenciesPart I
Are you ready???
Everyone has a different tolerance for emergencies.
You may have deliberately chosen to work in an environment where emergencies are less likely but……
Everyone has a different tolerance for emergencies.
You may have deliberately chosen to work in an environment where emergencies are less likely but……
Inevitably, emergencies WILL find you!Inevitably, emergencies WILL find you!
Preparing for Office EmergenciesPreparing for Office Emergencies
What is the extent of the problem?
How common are office emergencies?
What should I prepare for?
What is the extent of the problem?
How common are office emergencies?
What should I prepare for?
Preparing for Office emergenciesPreparing for Office emergencies
Not much literature regarding the frequency of office emergencies.
Not much literature regarding the frequency of office emergencies.
Nonetheless, it is unanimous is that we are unprepared!!!
Preparing for Office emergenciesPreparing for Office emergencies
The public has become hyperaware of safety issues and has great expectations.
If you collapse at the hockey rink you may expect to be defibrillated (AED), similarly, if you collapse at your doctor’s office, the expectation is that you will receive an immediate, skilled intervention.
AED costs ~$1000.00
The public has become hyperaware of safety issues and has great expectations.
If you collapse at the hockey rink you may expect to be defibrillated (AED), similarly, if you collapse at your doctor’s office, the expectation is that you will receive an immediate, skilled intervention.
AED costs ~$1000.00
Preparing for Office emergenciesPreparing for Office emergencies
Excellent article in Canadian Family Physician 2009
Can Fam Phys 55(10);Oct 2009: 1004-1005
Claire Liddy, Heather Dreise, and Isabelle Gaboury look at
“The Frequency of In-office Emergencies in Primary Care”
Excellent article in Canadian Family Physician 2009
Can Fam Phys 55(10);Oct 2009: 1004-1005
Claire Liddy, Heather Dreise, and Isabelle Gaboury look at
“The Frequency of In-office Emergencies in Primary Care”
Can Fam Phys 55(10);Oct 2009: 1004-1005
Liddy et. al.
Can Fam Phys 55(10);Oct 2009: 1004-1005
Liddy et. al.
They looked at ‘Code 4’ calls in the Ottawa area for a 3 yr period from 2004-2006.
Overall, there were 272,752 code 4 calls over the 3 yr period with 2% (3033) from primary care offices.
On average 1000 calls per year from community based offices!
They looked at ‘Code 4’ calls in the Ottawa area for a 3 yr period from 2004-2006.
Overall, there were 272,752 code 4 calls over the 3 yr period with 2% (3033) from primary care offices.
On average 1000 calls per year from community based offices!
Preparing for Office emergenciesPreparing for Office emergencies
0
5
10
15
20
25
30
35
Cardiovascular
Other
Respiratory
CNS
Endocrine
GI
MSK
Hematologic
GU
Preparing for Office emergenciesPreparing for Office emergencies
Office emergencies are actually NOT that rare!
Despite this fact, community based offices are often poorly prepared for emergency presentations!
J. Emerg Med 1986;4(1):71-74 Am. Acad. of FP 2005;12(1):34-36
Office emergencies are actually NOT that rare!
Despite this fact, community based offices are often poorly prepared for emergency presentations!
J. Emerg Med 1986;4(1):71-74 Am. Acad. of FP 2005;12(1):34-36
The CPSO has provided guidelines for preparing for office emergencies.
November 2005, Updated May 2012 http://www.cpso.on.ca/uploadedFiles/policies/guidelines/office/Safe-Practices.pdf
The CPSO has provided guidelines for preparing for office emergencies.
November 2005, Updated May 2012 http://www.cpso.on.ca/uploadedFiles/policies/guidelines/office/Safe-Practices.pdf
Preparing for Office emergenciesPreparing for Office emergencies
Community characteristics
Prone to severe weather? Is there a hospital in the
community? Is 911 available? What is the ambulance response
time?
Community characteristics
Prone to severe weather? Is there a hospital in the
community? Is 911 available? What is the ambulance response
time?
Preparing for Office emergenciesPreparing for Office emergencies
Preparing for Office emergenciesPreparing for Office emergencies
Practice characteristics
Scope of practice? Parenteral medications? High risk procedures? High volumes of ‘sick’ patients?
Practice characteristics
Scope of practice? Parenteral medications? High risk procedures? High volumes of ‘sick’ patients?
Preparing for Office emergenciesPreparing for Office emergencies
It’s important to assess your practice for the kinds of risks you may have to deal with.
eg. Psychotherapists vs geriatriciansvs practices that may encounter
mostly children. Predicting the likely types of
emergencies you may encounter will help guide establishing needed equipment and meds
It’s important to assess your practice for the kinds of risks you may have to deal with.
eg. Psychotherapists vs geriatriciansvs practices that may encounter
mostly children. Predicting the likely types of
emergencies you may encounter will help guide establishing needed equipment and meds
Preparing for Office emergenciesPreparing for Office emergencies
Essential equipment Stethoscope, BP measuring device O2, bag valve mask(adult and pediatric) Oral airways Oxygen tubing and masks Pulse oximeter Needles and syringes Aerochamber (Pediatric and Adult) N95 masks (?)
Essential equipment Stethoscope, BP measuring device O2, bag valve mask(adult and pediatric) Oral airways Oxygen tubing and masks Pulse oximeter Needles and syringes Aerochamber (Pediatric and Adult) N95 masks (?)
Preparing for Office emergenciesPreparing for Office emergencies
Preparing for Office emergenciesPreparing for Office emergencies
Optional equipment (as determined by your risk assessment)
Intubating equipment IV access and tubing ECG monitor Defibrillator Interosseus needles www.officeemergencies.ca
Optional equipment (as determined by your risk assessment)
Intubating equipment IV access and tubing ECG monitor Defibrillator Interosseus needles www.officeemergencies.ca
Preparing for Office emergenciesPreparing for Office emergencies
Basic Medications
ASA 80 mg (chewable)* NTG spray or tabs* Lorazepam 1mg sl tabs, Midazolam Epinephrine 1:1000* Diphenhydramine (Benadryl)* Glucagon Dextrose (injectable or gel)
* essential
Basic Medications
ASA 80 mg (chewable)* NTG spray or tabs* Lorazepam 1mg sl tabs, Midazolam Epinephrine 1:1000* Diphenhydramine (Benadryl)* Glucagon Dextrose (injectable or gel)
* essential
Preparing for Office emergenciesPreparing for Office emergencies
More medications
Ventolin* Atrovent* Cogentin Haldol Furosemide (Lasix) Oxytocin *essential
More medications
Ventolin* Atrovent* Cogentin Haldol Furosemide (Lasix) Oxytocin *essential
Preparing for Office emergenciesPreparing for Office emergencies
Basic training
BLS ACLS PALS
Basic training
BLS ACLS PALS
Preparing for Office emergenciesPreparing for Office emergencies
Useful paperwork
Death Certificate Form 1
Useful paperwork
Death Certificate Form 1
Preparing for Office emergenciesCPSO Self review
Preparing for Office emergenciesCPSO Self review
How does your facility and equipment fit into the risk assessment model and recommendations? -Based on your risk assessment, are you satisfied that your facility is equipped with appropriate emergency equipment? -Is your staff educated in the use of emergency equipment? -Does your staff participate in a regular review of emergency equipment to maintain competence? -Do you or your staff routinely check for expired drugs? -Are emergency equipment and associated supplies stored together for easy access in an emergency? -Is your staff aware of the steps to take in the event of an emergency?
Preparing for Office emergencies
CPSO Self review
Preparing for Office emergencies
CPSO Self review-Does your staff have updated training in CPR? -Does your medical facility have a documented plan to follow in the event of the following: • Fire/evacuation • Disruptive patient • Need to obtain security -Is 911 service available in the community? -Would it be possible for appropriate emergency personnel to reach the office within five minutes? -Are emergency plans posted in the medical facility for easy reference? SELF-EVALUATION: Risk Assessment Model
Preparing for Office emergenciesPreparing for Office emergencies
All emergency equipment should be located in ONE place that is easily accessible and known to ALL
All staff should be trained in the proper use of emergency equipment.
One staff member should regularly review contents of the emergency stock, checking exp. dates and reviewing content.
Preparing for Office emergenciesPreparing for Office emergencies
The emergency kit should also include:
Rx doses Breslow tapes, treatment algorithms
The emergency kit should also include:
Rx doses Breslow tapes, treatment algorithms
Preparing for Office emergenciesPart II
common office emergencies
Preparing for Office emergenciesPart II
common office emergencies
Ischemic chest pain Anaphylaxis Asthma Seizure Acute hemorrhage Syncope Form 1 intervention
Ischemic chest pain Anaphylaxis Asthma Seizure Acute hemorrhage Syncope Form 1 intervention
Preparing for Office emergenciesPreparing for Office emergencies
Unstable Ischemic Chest Pain
Call 911 for urgent transport to local emergency facility
Monitor BP, pulse and when available continuous O2 saturation
Supplemental O2 by mask or prongs Remain in attendance until paramedics
assume care IV access if possible
Unstable Ischemic Chest Pain
Call 911 for urgent transport to local emergency facility
Monitor BP, pulse and when available continuous O2 saturation
Supplemental O2 by mask or prongs Remain in attendance until paramedics
assume care IV access if possible
Preparing for Office emergenciesPreparing for Office emergencies
Unstable Ischemic Chest Pain
ECG where available
AED where available
Unstable Ischemic Chest Pain
ECG where available
AED where available
Preparing for Office emergenciesPreparing for Office emergencies
Medication
ASA 160mg po (2 x 80mg chewable) NTG if systolic BP > 100 mmHg 0.3-
0.4mg sl q5min x 3 doses* Morphine 2-4mg IV q 5minutes for pain
and anxiety
*Caution in Right ventricular MI, Hypotension, use of a phosphodiesterase inhibitor, aortic stenosis
Medication
ASA 160mg po (2 x 80mg chewable) NTG if systolic BP > 100 mmHg 0.3-
0.4mg sl q5min x 3 doses* Morphine 2-4mg IV q 5minutes for pain
and anxiety
*Caution in Right ventricular MI, Hypotension, use of a phosphodiesterase inhibitor, aortic stenosis
Preparing for Office emergenciesPreparing for Office emergencies
Complications Sudden death CHF, cardiogenic shock Hypotension Dysrhythmias
Complications Sudden death CHF, cardiogenic shock Hypotension Dysrhythmias
Preparing for Office emergenciesPreparing for Office emergencies
Severe asthma attack
Allay anxiety, calm, reassuring voice O2 by mask Monitor vitals and O2 sats PEFR (severe <50% predicted)
Severe asthma attack
Allay anxiety, calm, reassuring voice O2 by mask Monitor vitals and O2 sats PEFR (severe <50% predicted)
Preparing for Office emergenciesPreparing for Office emergencies
Severe Asthma AttackMedications
Ventolin MDI with aerochamber, 4-6 inhalations STAT, then 2 inhalations q30min PRN
Prednisone 1mg/kg po Atrovent MDI, 2 inhalations following
Ventolin
Severe Asthma AttackMedications
Ventolin MDI with aerochamber, 4-6 inhalations STAT, then 2 inhalations q30min PRN
Prednisone 1mg/kg po Atrovent MDI, 2 inhalations following
Ventolin
Preparing for Office emergenciesPreparing for Office emergencies
Severe asthma attack
If PEFR remains <50% expected after Tx, transport patient to the ER
If PEFR is not available, transport patient to the ER by EMS
Severe asthma attack
If PEFR remains <50% expected after Tx, transport patient to the ER
If PEFR is not available, transport patient to the ER by EMS
Preparing for Office emergenciesPreparing for Office emergencies
Preparing for Office emergenciesPreparing for Office emergencies
Seizures Most seizures are brief and self limited Protect patient Secure patient’s airway by positioning,
chin lift or jaw thrust if required. O2 by prongs or mask, Bag valve mask For a prolonged seizure or when there is
airway compromise a nasal trumpet, oral airway and suction if available.
Seizures Most seizures are brief and self limited Protect patient Secure patient’s airway by positioning,
chin lift or jaw thrust if required. O2 by prongs or mask, Bag valve mask For a prolonged seizure or when there is
airway compromise a nasal trumpet, oral airway and suction if available.
Preparing for Office emergenciesPreparing for Office emergencies
Seizures
+/- IV access for unremitting episode Glucometer Most seizures are self limited and
intervention is rarely required beyond assisting the patient.
Seizures
+/- IV access for unremitting episode Glucometer Most seizures are self limited and
intervention is rarely required beyond assisting the patient.
Preparing for Office emergenciesPreparing for Office emergencies
Seizures Medications
Dextrose gel po or D50W IV 50ml if hypoglycemic
Lorazepam 0.1mg/kg @ 2mg/min to a max of 10mg or
Diazepam rectally 0.5mg/kg up to 20mg or Midazolam 0.1-0.3mg/kg IM
Seizures Medications
Dextrose gel po or D50W IV 50ml if hypoglycemic
Lorazepam 0.1mg/kg @ 2mg/min to a max of 10mg or
Diazepam rectally 0.5mg/kg up to 20mg or Midazolam 0.1-0.3mg/kg IM
Preparing for Office emergenciesPreparing for Office emergencies
Preparing for Office emergencies
Preparing for Office emergencies
Anaphylaxis Prompt diagnosis essential for good
outcome 90% have skin manifestation or mucous
membrane Sx (itch, urticaria, erythema) Criteria 1: Acute onset, skin or mucous
membrane involvement + either i. respiratory symptoms or, ii. Hypotension (sys <90 or
>30% drop from baseline
Anaphylaxis Prompt diagnosis essential for good
outcome 90% have skin manifestation or mucous
membrane Sx (itch, urticaria, erythema) Criteria 1: Acute onset, skin or mucous
membrane involvement + either i. respiratory symptoms or, ii. Hypotension (sys <90 or
>30% drop from baseline
Preparing for Office emergencies
Preparing for Office emergencies
Anaphylaxis Criteria 2: Known exposure to a likely allergen with at least 2 of the following: i. skin or mucous membrane ii. Respiratory symptoms iii. hypotension iv. GI symptoms (abdo pain,diarrhea)
Anaphylaxis Criteria 2: Known exposure to a likely allergen with at least 2 of the following: i. skin or mucous membrane ii. Respiratory symptoms iii. hypotension iv. GI symptoms (abdo pain,diarrhea)
Preparing for Office emergencies
Preparing for Office emergencies
AnaphylaxisCriteria 3: hypotension after exposure to a known allergen.
In a review of 164 deaths from anaphylaxis,time to death from iatrogenic injectable=5 minutes! Commonest error on part ofmedical care= delay in epi administration
AnaphylaxisCriteria 3: hypotension after exposure to a known allergen.
In a review of 164 deaths from anaphylaxis,time to death from iatrogenic injectable=5 minutes! Commonest error on part ofmedical care= delay in epi administration
Preparing for Office emergenciesPreparing for Office emergencies
Anaphylaxis Remove offending allergen Call for help, call 911 O2 by prongs or mask Epinephrine (1:1000) IM IV if available, NS or RL wide open*
* establishment of an IV should not delay administration of epinephrine
Anaphylaxis Remove offending allergen Call for help, call 911 O2 by prongs or mask Epinephrine (1:1000) IM IV if available, NS or RL wide open*
* establishment of an IV should not delay administration of epinephrine
Preparing for Office emergenciesPreparing for Office emergencies
Anaphylaxis - Medications
Epinephrine 0.3ml 1:1000 IM q20min (adult)
Epinephrine 0.01ml/kg 1:1000 IM q20min (peds)
Anaphylaxis - Medications
Epinephrine 0.3ml 1:1000 IM q20min (adult)
Epinephrine 0.01ml/kg 1:1000 IM q20min (peds)
Preparing for Office emergenciesPreparing for Office emergencies
Anaphylaxis - Medications
If patient is taking Beta blockers, epinephrine may be less effective, in this setting:
Glucagon 1-2mg IM in adults 20-30mcg/kg up to 1mg in children
Anaphylaxis - Medications
If patient is taking Beta blockers, epinephrine may be less effective, in this setting:
Glucagon 1-2mg IM in adults 20-30mcg/kg up to 1mg in children
Preparing for Office EmergenciesPreparing for Office Emergencies
Sepsis
Definition: A clinical syndrome characterized by systemic inflammation due to infection
The challenge: RECOGNISE IT
Sepsis
Definition: A clinical syndrome characterized by systemic inflammation due to infection
The challenge: RECOGNISE IT
Preparing for Office emergenciesPreparing for Office emergencies
Sepsis Therapeutic priority: 1. Transport patient to nearest ER
2. Correct hypoxemia, hypotension
3. Identify and treat infection
Sepsis Therapeutic priority: 1. Transport patient to nearest ER
2. Correct hypoxemia, hypotension
3. Identify and treat infection
Preparing for Office emergenciesPreparing for Office emergencies
Sepsis - Treatment Treatment
-Supplemental oxygen
-Continuous SO2 monitoring
-Large bore IV (depending on
access to EMS) and fluids +++
Sepsis - Treatment Treatment
-Supplemental oxygen
-Continuous SO2 monitoring
-Large bore IV (depending on
access to EMS) and fluids +++
Preparing for Office emergenciesPreparing for Office emergencies
Sepsis – Treatment -Assess perfusion: colour,
temperature, restlessness, confusion
- Hypoperfusion can occur in the absence of hypotension
- transport to ER STAT
Sepsis – Treatment -Assess perfusion: colour,
temperature, restlessness, confusion
- Hypoperfusion can occur in the absence of hypotension
- transport to ER STAT
Preparing for Office emergenciesPreparing for Office emergencies
Serotonin Syndrome
In the US in 2005 there were 8000+ cases with 103 deaths. Most require ICU admit.
Often results from a combination of meds that increase serotonergic neurotransmisssion
Often presents within 24hrs of new Rx or change in dose
Serotonin Syndrome
In the US in 2005 there were 8000+ cases with 103 deaths. Most require ICU admit.
Often results from a combination of meds that increase serotonergic neurotransmisssion
Often presents within 24hrs of new Rx or change in dose
Preparing for Office emergenciesPreparing for Office emergencies
Serotonin Syndrome
Classic triad:
1. Altered mental status
2. Autonomic hyperactivity 3. Neuromuscular abnormalities
Incidence increasing with use of SSRIs
Serotonin Syndrome
Classic triad:
1. Altered mental status
2. Autonomic hyperactivity 3. Neuromuscular abnormalities
Incidence increasing with use of SSRIs
Preparing for Office emergenciesPreparing for Office emergenciesSerotonin Syndrome
Mental status changes: Anxiety, agitated delirium, restlessness
Autonomic changes: Diaphoresis, tachycardia, hyperthermia, vomiting, diarrhea, HTN
Neuromuscular changes: Tremor, rigidity, myoclonus, hyperreflexia,
Serotonin Syndrome
Mental status changes: Anxiety, agitated delirium, restlessness
Autonomic changes: Diaphoresis, tachycardia, hyperthermia, vomiting, diarrhea, HTN
Neuromuscular changes: Tremor, rigidity, myoclonus, hyperreflexia,
Preparing for Office emergenciesPreparing for Office emergenciesSerotonin Syndrome
Hunter Toxicity Criteria Decision Rules:
Ingestion of serotonergic agent + 1 of: Spontaneous clonus Inducible clonus + agitiation or delerium Ocular clonus + agitation or delerium Tremor or hyperreflexia Hypertonia Temp > 38 + ocular or inducible clonus
Serotonin Syndrome
Hunter Toxicity Criteria Decision Rules:
Ingestion of serotonergic agent + 1 of: Spontaneous clonus Inducible clonus + agitiation or delerium Ocular clonus + agitation or delerium Tremor or hyperreflexia Hypertonia Temp > 38 + ocular or inducible clonus
Preparing for Office emergenciesPreparing for Office emergencies
Serotonin SyndromeTreatment
Call 911 and prepare for transport Supportive care:
O2 Monitor vitals +/- IV fluids Benzodiazepines (Midazolam) Cyproheptadine 8mg
Serotonin SyndromeTreatment
Call 911 and prepare for transport Supportive care:
O2 Monitor vitals +/- IV fluids Benzodiazepines (Midazolam) Cyproheptadine 8mg
Preparing for Office emergenciesPreparing for Office emergencies
Form 1 Intervention 46 yrs old male patient reports depressive
symptoms worsened by suspicions that his wife is having an affair with a neighbor.
He tells you that he harbours thoughts of killing himself, but not before settling a “few scores”.
He is vague but you are left feeling very uncomfortable and anxious about homicidal ruminations.
You should……..
Form 1 Intervention 46 yrs old male patient reports depressive
symptoms worsened by suspicions that his wife is having an affair with a neighbor.
He tells you that he harbours thoughts of killing himself, but not before settling a “few scores”.
He is vague but you are left feeling very uncomfortable and anxious about homicidal ruminations.
You should……..
Preparing for Office emergenciesPreparing for Office emergencies
1. Reassure him that he is likely incorrect and arrange for a family meeting next week.
2. Start him on Celexa 10mg po qam and titrate to effect.
3. Discuss voluntary hospital admission and involuntarily admit him if he refuses. (Form 1)
4. Contract with the pt to do no harm, refer to psychiatry and follow up with him in 48 hrs.
1. Reassure him that he is likely incorrect and arrange for a family meeting next week.
2. Start him on Celexa 10mg po qam and titrate to effect.
3. Discuss voluntary hospital admission and involuntarily admit him if he refuses. (Form 1)
4. Contract with the pt to do no harm, refer to psychiatry and follow up with him in 48 hrs.
Preparing for Office emergenciesPart III
Preparing for Office emergenciesPart III
Build the BoxBuild the Box
Be Ready
Preparing for Office emergenciesPreparing for Office emergencies
Build the Box- Medications Epinephrine 1:1000 3 amps ASA 80mg* NTG 0.4mg sublingual spray* Benadryl 50mg tabs* Glucagon, preloaded syringes Ventolin MDI with aerochamber, adult / peds* Atrovent MDI* Dextrose gel, tabs* Ativan 1mg s.l. tabs Midazolam 5mg/ml injectable Cogentin 2mg/ml injectable *essential
Build the Box- Medications Epinephrine 1:1000 3 amps ASA 80mg* NTG 0.4mg sublingual spray* Benadryl 50mg tabs* Glucagon, preloaded syringes Ventolin MDI with aerochamber, adult / peds* Atrovent MDI* Dextrose gel, tabs* Ativan 1mg s.l. tabs Midazolam 5mg/ml injectable Cogentin 2mg/ml injectable *essential
Preparing for Office emergencies
Preparing for Office emergencies
Build the Box - Equipment Syringes 3cc-10cc* Needles 18g, 25g 1”, 1 1/2”* O2 sat probe Glucometer O2 tubing* O2 masks, peds to adult* O2 supply* Oral airways, nasal trumpets* Bag valve mask*
*essential
Build the Box - Equipment Syringes 3cc-10cc* Needles 18g, 25g 1”, 1 1/2”* O2 sat probe Glucometer O2 tubing* O2 masks, peds to adult* O2 supply* Oral airways, nasal trumpets* Bag valve mask*
*essential
Preparing for Office emergenciesPreparing for Office emergencies
Build the Box- Equipment
OPTIONAL (depends on practice risk assessment):
ETT sizes 4.5-8.0 Laryngoscope handle and blades 2-4 MacIntosh McGill forceps AED Interosseous needles IV tubing, IV needles (24-16g), Normal saline
Build the Box- Equipment
OPTIONAL (depends on practice risk assessment):
ETT sizes 4.5-8.0 Laryngoscope handle and blades 2-4 MacIntosh McGill forceps AED Interosseous needles IV tubing, IV needles (24-16g), Normal saline
Preparing for Office emergenciesPreparing for Office emergencies
Build the Box- Algorithms
Laminated sheets with clearly defined, step by step algorithms.
Box may be organized according to emergency type and are commercially available
Build the Box- Algorithms
Laminated sheets with clearly defined, step by step algorithms.
Box may be organized according to emergency type and are commercially available
Preparing for Office emergencies Build (or buy) the Box
Preparing for Office emergencies Build (or buy) the Box
www.stores.criticalcaresolutionsstore.comApprox $600 U.S.
Preparing for Office emergenciesPreparing for Office emergencies
SUMMARY:1. It will happen2. Be ready:
1. Assess your practice 2. Office staff should have clear
responsibilities3. Have an emergency response kit that is
up to date and readily available
SUMMARY:1. It will happen2. Be ready:
1. Assess your practice 2. Office staff should have clear
responsibilities3. Have an emergency response kit that is
up to date and readily available
Prepared for Office emergenciesPrepared for Office emergencies
Questions/Discussion
Questions/Discussion