SLO6 – Practical Procedures

Authors: Charlotte Davies / Editor: Liz Herrieven/ Codes: SLO6 / Published: 21/12/2021

If you have a look at the RCEMLearning linked page for SLO6, you’ll see lots of exciting resources. They’re grouped by SLO rather than any specific curriculum item, so we thought we’d create this mini summary of the resources we’ve found here and elsewhere to enable you to get the background to proficiently deliver and teach emergency medicine skills.

There’s lots of tips for DIY mannikins in our blog post here,  and on the #RCEMDIY hashtag and we’ve signposted to these in the individual sections where possible.

If you’d like to add an RCEMLearning link, please get in touch.
If you’d like to recommend a different resource or mannikin, please also get in touch!!

DC Cardioversion
Curriculum specifies: e-learning or ALS, simulation and observed “instruction of management of tachydysrhythmia”.
Simulation: can be done using your resus mannikins, or you can download apps like simpl (£, and needs active wifi to sync with iPad)

Resources: A blog post is pending discussing some of the nuances of cardioversion and sedation.
Reference: Broad Complex
Reference: SVT
SAQ: Tachycardia
SAQ: Cardioversion
Learning: Broad Complex

External Pacing
Curriculum specifies e-learning or ALS, observed or simulation practice, observed “instruction of management of bradydysrhythmias”. 
Simulation: can be done using your resus mannikins, or you can download apps like simpl (£, and needs active wifi to sync with iPad)

Resources: Our pacing blog was released in February 22, and discusses many of the nuances. 
Reference Bradycardia
Learning Bradycardia

NIV
Curriculum  specifies e-learning on NIV, observation or sim
Simulation: can be done using your kit in resus – have a training set of tubes. Use the checklist found in the blog to help.
Resources: Blog NIV set up 

Joint Aspiration
Curriculum specifies e-learning, observed or simulated
Simulation: Your meded centre is likely to have a mannikin. They’re about £2,000 – and if you need one to meet training requirements, speak to your TPD/ HEE .
Resources: SAQ that covers loads of information on knee aspiration, and essentially teaches it. 

Non RCEM Resources: Broome Docs and Bromley Emergency Courses have good videos. 

Airway Management
The curriculum specifies you should cover emergency surgical airway, RSI in sim or real life (including ATLS we assume). 10 logged procedures/year.
Simulation: Your resus department will have many airway heads, and your anaesthetic department might even let you borrow theirs and support some teaching! 

RCEM Resources: Reference on Basic Airway Management and e-learning here
Reference on Difficult Airway Management with e-learning here
Reference on RSIs
SAQs on the emergency surgical airway, difficult airway
Podcast on the airway

Non RCEM Resources: The paediatric airway from Bromley Courses

Major Haemorrhage
Curriculum states sim or observed practice to include: Nasal packing, Splints – pelvic sling, traction splint, Tourniquet, Haemostatic agents, Varicose Veins

Simulation: Most people use an airway mannikin for epistaxis management but you can get a mannikin for about £700. We tested the mannikin and found it wasn’t great for packing, and was a little useful for cauterisation. Does anyone have mannikin suggestions? For non epistaxis, we generally practice on colleagues! 

RCEM Resources: acute epistaxis, trauma iBook, managing major haemorrhage
If you’d like to contribute a blog or other resource on major haemorrhage management (more on varicose veins, or blood transfusions etc., please get in touch with the team). 

Non RCEM Resources: 
London trauma school 
Kendrick splint from EM3

Emergency Childbirth and Resuscitative Hysterotomy 
Curriculum states E-learning and sim
Simulation: Your medical student teaching colleagues may have a pelvis and neonate to simulate a normal delivery. You can get a perimortem section mannikin from limbs and things. If your hospital runs the PROMPT course, they may have mannikins to share. Alternatively, #RCEMDIY has lots of ideas. The limbsandthings model is being redeveloped – their current version doesn’t work well for a vertical incision but is better than nothing.  

RCEM Resources: Call the Midwife! (and other tips on ED deliveries), Resuscitative Hysterotomy (perimortem c-section)

Ultrasound
Curriculum states e-learning – Echo in life support, AAA, eFAST / FAFF, PTX, Shock Assessment
Simulation: There are loads of ultrasound simulators available. What’s your preference?

RCEM Resources: Physics of USS module and indications and level 1 reference
Echo in Life Support: reference session
AAA: Module, SAQ in out and hold 
eFAST & PTX: Learning session 
Shock Assessment and Vascular acccess: ultrasound skills of ultrasound guided vascular access, ACES reference

Non RCEM Resources: echo in life support

Open  and Seldinger Chest Drain
Curriculum says: NatSSIPs checklist. Seldinger drain is also on the ACCS checklist.
Simulation: Chest drain models are available, and if you’re buying a new one, make sure it is ultrasound compatible. If you teach ATLS your hospital may already have them, or easy access to animal simulators. Alternatively, have a look at #RCEMDIY.  

RCEM Resources: 
chest drain insertion in adult trauma
chest drain insertion a practical guide
chest drain insertion a practical guide module
chest drain insertion in adult trauma

Non RCEM Resources: Chest Drain

Thoracotomy
Curriculum says E-learning and sim
Simulation: Chest drain models are available, and if you’re buying a new one, make sure it is ultrasound compatible. If you teach ATLS your hospital may already have them, or easy access to animal simulators. Alternatively, have a look at #RCEMDIY.  

RCEMResources: 
emergency department thoracotomy
traumatic cardiac arrest
foamed may 2018

Paediatric Sedation
Curriculum says Observed DOPS
Simulation: Your resus department will have paediatric mannikins. 

RCEMResources: 
procedural sedation emergency medicine
ketamine sedation in children
a primer on procedural sedation

Lateral Canthotomy
Curriculum says E-learning and sim
Simulation: There is no mannikin commercially available, but plenty of suggestions on #RCEMDIY. 

RCEMResources: Sight for Sore Eyes

Non RCEM Resources: resus drills lateral canthotomy

Pericardiocentesis
Curriculum says sim.
We’re waiting for some resources on this. If you could write them or signpost, please let us know! 
Simulation: There is a model available from limbsandthings that is USS compatible. We didn’t attempt to purchase it as although it did what it said on the tin, it didn’t add more than watching videos. 

Fractures and Splinting
Curriculum says supervised splinting and DOPS of: Shoulder, Elbow, Wrist, Finger, Hip, Femur, Lower leg, Ankle, Toes, Mandible
Simulation: There is a commercially available colles fracture model available from limbsandthings, and #RCEMDIY has some suggestions for dislocation models. 

Upper Limb Resources:
colles fracture
relocation relocation relocation
youtube.com
pulled elbow relocation

Elbow Dislocation
Shoulder Reduction
traumatic hip dislocation in a young woman a complication
paedsy procedures
trauma iBook an introduction
mandibular and temporomandibular joint injuries
relocation relocation relocation module
Tessa Davis Twitter

Lower Limb Resources: 
Kendrick Splint video from DFTB
Kendrick Splint handout from RCEMLearning
Ankle dislocation from Bromley

Fascia Iliaca Block
FIB is mentioned in the ACCS competencies. It’s covered well on RCEMLearning.
Simulation: There’s a mannikin from traumasimulation here, but it doesn’t seem to be ultrasound compatible. For DIY options, read our RCEMLearning article here.

RCEM Resources: FIB module

Lumbar Puncture
This is on the ACCS competency list. 
Simulation: You can get mannikins for this – does anyone have recommendations? 

RCEM Resources: This could be the module that you write! 

Setting up Central Lines and ART Lines
This is on the ACCS Competency list. 

RCEM Resources: This could be the module that you write! 
Non RCEM Resources: EDEducate has fabulous videos on this. 

If we’ve missed a curriculum item, or your favourite resource, or any RCEMLearning resources, or you’d like to write something – or anything else, please get in touch! 

1 Comments

  1. Dr. Tirtha Taposh Saha Roy says:

    This is an excellent article with all the necessary links attached herewith.
    Very much appreciated

Leave a Reply