Practice Procedures

Definitive airway for failure to oxygenate, ventilate, or protect the airway, or anticipated clinical course.

Emergent airway for a 'can't intubate, can't ventilate' (CICV) situation.

Manual positive-pressure ventilation and oxygenation for the apneic or inadequately breathing patient, including pre-oxygenation and rescue ventilation.

Heated, humidified high-flow oxygen for hypoxemic respiratory failure when a non-invasive support that improves oxygenation and work of breathing is needed.

Supraglottic airway adjunct for ventilation when bag-valve-mask is inadequate or as a rescue device when intubation fails.

Positive-pressure support to avoid intubation in COPD exacerbation, pulmonary edema, or hypoxemic respiratory failure without impending respiratory arrest.

Sedation and analgesia to perform a painful or anxiety-provoking procedure while preserving airway reflexes.

Central venous access for resuscitation, vasoactive infusions, hemodynamic monitoring, or poor peripheral access.

Continuous arterial blood pressure monitoring or frequent arterial blood sampling in critically ill patients.

Rapid vascular access when peripheral IV access fails or is unavailable in a critically ill or arrest patient.

Emergent vascular access in the neonate for fluids, medications, blood sampling, or monitoring via the umbilical vein or artery.

Sampling of cerebrospinal fluid (e.g., suspected meningitis or subarachnoid hemorrhage) or measurement of opening pressure.

Drainage of the pleural space for hemothorax, pneumothorax requiring suction, or empyema.

Restoration of sinus rhythm in an unstable tachyarrhythmia with a pulse.

Unsynchronized shock for pulseless ventricular tachycardia or ventricular fibrillation.

Simple pneumothorax or small pleural effusions amenable to small-bore drainage.

Temporary electrical pacing for symptomatic bradycardia unresponsive to atropine or high-grade AV block with hemodynamic compromise.

Regional analgesia for hip and proximal femur fractures (femoral and lateral femoral cutaneous nerve distribution).

Regional anesthesia of the external ear for laceration repair, drainage, or other procedures on the auricle.

Regional anesthesia of the forearm and hand for procedures distal to the elbow.

Regional anesthesia and analgesia of the femoral nerve distribution, for example for anterior thigh and femoral shaft pain.

Local anesthesia of a fracture site to permit closed reduction (e.g., distal radius fracture).

Anesthesia of the lower teeth, mandible, lower lip, and anterior tongue for mandibular dental pain or laceration repair.

Regional anesthesia of the ipsilateral lower eyelid, lateral nose, and upper lip (e.g., for laceration repair in the infraorbital nerve distribution).

Anesthesia of the lower lip, chin, and labial gingiva for laceration repair or procedures in the mental nerve distribution.

Regional anesthesia of the penis for procedures such as reduction of paraphimosis, dorsal slit, foreskin repair, or laceration repair.

Regional anesthesia of the sole of the foot (plantar aspect) and medial calcaneal region, for example for plantar wound repair or foreign body removal.

Regional analgesia of the hemithorax for rib fractures, chest wall trauma, or thoracic procedures.

Regional anesthesia of the ipsilateral forehead and scalp to the vertex, for forehead laceration repair or other anterior scalp procedures.

Regional anesthesia of the hand for laceration repair, foreign body removal, fracture reduction, or other painful procedures involving the radial, median, and ulnar nerve distributions.

Aspiration of joint fluid for diagnosis (e.g., septic arthritis, crystal arthropathy) or therapeutic decompression.

Reduction and immobilization of fractures and dislocations to restore alignment, relieve pain, and protect neurovascular structures.

Protection of the spine in suspected cervical or spinal injury until clinical or imaging clearance.

Imminent vaginal delivery in the emergency department when transfer to labor and delivery is not possible.

Hemorrhage control for anterior or posterior nasal bleeding.

Direct visualization of the nasopharynx, hypopharynx, and larynx to assess airway patency, vocal cord mobility, lesions, edema, or foreign bodies, and to guide awake nasal intubation.

Magnified, illuminated examination of the anterior segment of the eye for ocular complaints such as foreign body, abrasion, infection, or anterior chamber pathology.

Systematic approach to the undifferentiated critically ill or shocked patient, from resuscitation bay setup through primary survey, access, shock classification, and targeted therapy.

Resuscitation of the depressed or non-vigorous newborn (not term, poor tone, or not breathing/crying) following the NRP algorithm.

Systematic resuscitation of the critically ill or arresting child, where weight-based dosing and age-specific physiology drive every intervention.

Systematic primary survey and resuscitation of the major trauma patient to find and treat immediately life-threatening injuries.

Repair of an acute traumatic laceration to restore hemostasis, function, and cosmesis after exploration and decontamination.