Procedures in the Emergency Department

Original Date: 02/2016 | Last Review Date: 04/2024
Purpose: To facilitate management of chest tube insertion procedures by residents and fellows in the ED.

Adult patients (age 16 and over)

Chest tube insertion procedures will be divided as follows:

  • Emergency chest tubes (required for hypotension or during primary survey prior to CT scan) are performed by the most experienced readily available provider at discretion of trauma faculty.
    • Non-level 1 patients should be upgraded to level 1 immediately with call to trauma chief while preparations are made to prepare patient for chest tube insertion without delay
  • Stable chest tubes will be distributed equitably between trauma residents and emergency medicine residents and supervised by trauma faculty unless not available within 30 minutes and then tube insertion should proceed under EM faculty supervision.
    • Upgrade to urgent consult remains a priority
    • EM residents will perform chest tube on odd days
    • Trauma residents will perform chest tube on even days
    • Performing resident should consent patient and prepare patient for chest tube insertion pending trauma faculty

FAST procedure will be divided as follows:

  • Level 1 trauma activations:
    • EM resident/intern will perform FAST during initial evaluation
    • Trauma resident may additionally perform FAST on odd days after stabilization of patient
    • EM faculty will oversee FAST performance and provide primary interpretation
  • For all other trauma patients the FAST will be performed by EM providers per normal operations

Trauma airway management:

  • Anticipated difficult or bloody airways will be managed by EM expertise
  • Stable intubations on select trauma patients can be managed with trauma/critical care fellow under direct EM faculty supervision