Procedures

A

• Airway Suctioning - Oropharyngeal and Tracheal

  Airway suctioning removes secretions that a patient cannot clear effectively; it should be performed for a clinical indication rather than on a fixed schedule. Use aseptic technique for tracheal suction.
• Arterial Line - Radial Placement

  Optimize waveform accuracy and safety with Allen test, ultrasound guidance, pressure transducer setup, and vigilant limb monitoring. Prepare the site with aseptic technique and chlorhexidine-alcohol when appropriate, use sterile gloves and equipment, and infiltrate local anesthetic if the patient is awake.

B

• Bag Valve Mask Ventilation - Effective Technique

  Proper mask seal, airway positioning, and gentle ventilation prevent hypoxia and gastric insufflation; two-person technique preferred. Use an appropriately sized mask and airway adjunct, optimize head and neck position when permitted, and prioritize a two-person technique when ventilation is difficult: one clinician uses both hands to create jaw thrust and mask seal while the second squeezes the bag.
• Bedside Echo - Focused Cardiac Ultrasound

  Focused cardiac ultrasound is a goal-directed bedside examination designed to answer a small number of urgent questions rather than reproduce a comprehensive echocardiogram. Use findings to refine—not replace—the resuscitation plan.
• Blood Cultures - Aseptic Collection

  Blood cultures are most useful when true bloodstream infection is plausible and the result will change antimicrobial or source-control decisions. Perform hand hygiene, disinfect bottle tops, prepare the venipuncture site with an appropriate antiseptic such as chlorhexidine-alcohol, allow it to dry completely, and avoid repalpating the prepared site unless sterile technique is maintained.
• Burn Wound - Initial Dressing and Care

  Initial burn care combines trauma-style stabilization with rapid characterization of burn depth, total body surface area, location, mechanism, and associated inhalation, electrical, chemical, or circumferential injury. After cleansing, cover minor superficial partial-thickness burns with a nonadherent moist protective dressing and choose topical therapy based on depth, location, allergy, and local practice.

C

• Central Venous Catheter - Ultrasound-Guided Internal Jugular

  Real-time ultrasound reduces complications; strict sterile technique, correct vein identification, wire control, and post-placement verification. Use hand hygiene, cap, mask, sterile gown, sterile gloves, a full-body sterile drape, chlorhexidine-alcohol skin preparation when appropriate, and sterile ultrasound gel and probe cover.
• Cricothyrotomy - Surgical Airway

  When cannot intubate, cannot oxygenate: rapid identification of membrane, vertical skin incision, horizontal membrane incision, tube placement. Call for help, continue attempts at oxygenation, extend the neck if safe, stabilize the larynx, identify the cricothyroid membrane, make a skin incision and membrane opening, and establish a cuffed airway using the institution's practiced technique and equipment.

D

• DVT Ultrasound - Two-Point Compression

  Bedside compression ultrasound can rapidly identify many proximal lower-extremity deep-vein thromboses when integrated with pretest probability. A positive proximal compression study in the correct clinical context generally warrants anticoagulation unless contraindicated and may be confirmed or managed according to local pathways.

E

• Ear Procedures - Cerumen Disimpaction and Foreign Body Removal

  Cerumen impaction and external-ear foreign bodies should be approached with object-specific technique and careful assessment of the tympanic membrane. Use direct visualization and the technique most likely to work on the first attempt: forceps for graspable material, curette or suction for selected objects, and irrigation only when safe and the object will not swell or react.
• Endotracheal Intubation - Rapid Sequence Intubation

  Structured preoxygenation, precise dosing, first-pass success strategy, and post-intubation sedation with ventilator setup. Prepare monitoring, suction, airway equipment, backup devices, rescue oxygenation, and a surgical-airway plan before medications are given.
• Epistaxis Control - Anterior Cautery and Packing

  Most epistaxis is anterior and can be controlled with simple measures, but the first priorities are airway, hemodynamic stability, and identification of anticoagulant use or a posterior source. Topical oxymetazoline or another vasoconstrictor can improve visualization and control.
• Eye Care - Corneal Foreign Body Removal and Fluorescein Exam

  Corneal foreign-body care begins with visual acuity and exclusion of an open globe, not with immediate removal. Use topical anesthetic in the clinical setting for examination and removal, then reassess the defect.

F

• FAST Exam - Focused Assessment with Sonography in Trauma

  The FAST examination is a rapid bedside ultrasound survey used in trauma to look for free fluid in the pericardial, right upper quadrant, left upper quadrant, and pelvic spaces. Perform FAST early when it can change action and repeat it after resuscitation or clinical change because free fluid may accumulate over time.
• Foley Catheter - Insertion and Troubleshooting

  Use aseptic technique, correct catheter size, confirm urine return, advance to bifurcation before balloon inflation; handle difficult male urethra carefully. Use aseptic technique, sterile equipment, the smallest appropriate catheter, and adequate lubricant.

I

• Incision and Drainage - Cutaneous Abscess

  Local anesthesia, adequate incision, blunt loculation disruption, irrigation, and appropriate packing or loop drainage. Prepare and anesthetize the area, make an incision adequate for drainage, break up accessible loculations gently, irrigate selectively, and consider packing only when the cavity or bleeding characteristics justify it; routine packing of small uncomplicated abscesses often adds pain without clear benefit.
• Intraosseous Access - Adult and Pediatric

  Rapid vascular access via proximal tibia or humerus; confirm flow and avoid extravasation; transition to IV when feasible. Identify the landmark, prepare the skin, insert the device perpendicular to the target cortex according to site and manufacturer technique, and confirm stability plus easy saline flush without soft-tissue swelling.

K

• Knee Arthrocentesis - Aspiration and Injection

  Sterile aspiration via lateral suprapatellar approach improves diagnosis and symptoms; send labs and consider steroid injection when indicated. Use sterile technique and an anatomic or ultrasound-guided approach, anesthetize the skin and tract, enter the joint without contaminating the needle, and aspirate as much diagnostic fluid as needed.

L

• Laceration Repair - Suturing Basics

  Irrigation, exploration, tension-free layered closure, and appropriate suture choice with tetanus update as needed. Irrigate adequately, remove visible contamination and devitalized tissue conservatively, anesthetize, and choose closure method based on tension, depth, location, cosmetic requirements, and contamination.
• Lumbar Puncture - Technique and CSF Handling

  Use proper positioning, landmarking or ultrasound assist, atraumatic needle when possible, and correct CSF tube handling. Position the patient lateral decubitus when an accurate opening pressure is needed, or seated when anatomy makes access difficult.

N

• Nail Procedures - Paronychia Drainage and Subungual Hematoma Trephination

  Paronychia and subungual hematoma are common nail complaints but require different procedures. Drain paronychia with the least traumatic method that fully decompresses pus, irrigate as needed, and leave the nail plate in place when possible.
• Nasogastric or Orogastric Tube - Placement and Confirmation

  Measure, lubricate, insert with head flexed, and confirm position with appropriate methods before use. Position the patient upright when possible, measure an appropriate insertion length according to local method, lubricate the tube, and advance gently while encouraging swallowing when safe.
• Needle Decompression - Tension Pneumothorax

  Immediate decompression in unstable suspected tension pneumothorax with large-bore catheter, followed by definitive tube thoracostomy.

P

• Paracentesis - Diagnostic and Therapeutic

  Ultrasound localization, lateral lower quadrant site, small needle for diagnostic and large-volume drainage when therapeutic; give albumin when indicated. Use ultrasound to identify a fluid pocket and avoid bowel, solid organs, and abdominal wall vessels.
• Peripheral IV - Ultrasound-Guided Difficult Access

  Use linear probe to identify target vein, align needle under real-time visualization, and secure extended-length catheter. Use hand hygiene, clean or sterile gloves according to institutional policy, appropriate skin antisepsis, and sterile single-use ultrasound gel for the percutaneous procedure.
• Peripheral Nerve Block - Femoral Block Basics

  A femoral nerve block provides regional analgesia for selected injuries and procedures involving the anterior thigh, femur, and knee. Use sterile skin preparation, probe cover, and gel; advance the needle in-plane or out-of-plane according to expertise; aspirate before each incremental injection; and observe spread around the nerve rather than injecting against high resistance.
• Procedural Sedation and Analgesia - Safety and Dosing

  Procedural sedation and analgesia is a monitored state that allows a painful or anxiety-provoking procedure while preserving safety across a continuum that can deepen unexpectedly. Use a dedicated monitoring clinician when feasible, establish suction, oxygen, bag-mask ventilation, airway equipment, and reversal agents before giving sedatives, and titrate one small dose at a time to effect.

S

• Shoulder Dislocation - Anterior Reduction Techniques

  Anterior shoulder dislocation typically presents with severe pain, loss of the normal rounded shoulder contour, and the arm held slightly abducted and externally rotated. Provide analgesia and choose the least-forceful reduction method appropriate to the patient.
• Splinting - Common Upper Extremity Splints

  Choose correct splint type and position of function to immobilize while minimizing stiffness and pressure injury. Pad bony prominences generously, use a splint rather than a circumferential cast when swelling is expected, mold without creating focal pressure, and leave fingers visible when possible for neurovascular monitoring.
• Sterile Technique - Barrier Precautions and Field Setup

  Sterile technique is a system for preventing microorganisms from entering a procedural field, device tract, wound, or normally sterile body space. Open sterile supplies without reaching over or touching the sterile interior, keep sterile items above waist and in view, and treat any uncertain item as contaminated.

T

• Thoracentesis - Ultrasound-Guided

  Ultrasound marking reduces pneumothorax; stay above rib to avoid neurovascular bundle, remove modest volumes with monitoring. Position the patient to optimize the dependent fluid pocket, mark or maintain real-time ultrasound visualization, use sterile technique and local anesthesia, and enter just above the superior border of the rib to reduce intercostal neurovascular injury.
• Tube Thoracostomy - Chest Tube Insertion

  Safe triangle approach, blunt dissection above rib, finger sweep, and secure fixation with underwater seal or suction. Use sterile preparation, adequate analgesia or sedation, and an insertion site chosen for the indication and anatomy, generally within the safe lateral thoracic zone.

W

• Wound Care - Bedside Sharp Debridement

  Remove devitalized tissue to reduce bioburden and promote healing; protect viable structures and control pain. Use adequate lighting, analgesia, sterile or clean technique appropriate to the setting, and instruments that allow controlled removal of clearly nonviable tissue.