COVID-19 Tailored RSI Bulletin

COVID-19 Tailored RSI Bulletin


  • Safety first!
  • Perform Hand Hygiene.
  • Enhanced PPE is required for Aerosol-generating Medical Procedures (AGMP): N95 respirator or powered air-purifying respirator (PAPR) device, face shield or goggles, gown, and double gloves.
  • Minimize providers in the room to the number necessary to provide safe intubation.
  • Airborne infection isolation rooms, if available.


  • Have an intubation plan; use a checklist.
  • Assess for intubation difficulty.
  • Early preparation of drugs and equipment.
  • All necessary equipment is assembled inside the room.
  • Standard monitoring.
  • Connect viral/bacterial filter to circuits and manual ventilators.
  • Use a closed suctioning system.
  • A rescue plan for intubation failure
  • Ensure team dynamics


Non-bagging approach:

  • Five minutes of pre-oxygenation with oxygen 100% using a non-rebreather mask.
  • Place hydrophobic filter between facemask and breathing circuit.
  • Recommended by experts due to less aerosol generation.
  • Might be non-sufficient.

Avoid the use of high-flow nasal oxygenation and mask CPAP or BiPAP due to a greater risk of aerosol generation.

EMCRIT mentioned the following approaches for Pre-oxygenation

NIPPV (Might be acceptable in a negative pressure room)

  • A 2-tube system (closed circuit) with two viral filters. 
  • Place on CPAP/PSV, leave the PSV at 0, PEEP only if the patient’s saturations do not come up with 100% fiO2.

BVM with Viral Filter

  • Turn BVM flow up to the flush rate.
  • Place a NIPPV mask to allow good seal with you away from the patient or just hold two hands on the mask in a thumbs-forward grip from safer airways.
  • The addition of nasal cannula underneath will allow CPAP with the PEEP valve if needed. 
  • Turn NC up to 4-6 L/m if this used. 

Paralysis and Induction

  • High-dose paralytic to inhibit cough.
  • Appropriate induction agents.


  • Head extension, often with flexion of the neck on the body.
  • Full sniffing position with cervical spine extension and head elevation.

Placement of Tube

  • The most experienced physician should perform the intubation.

Use video laryngoscopy rather than regular laryngoscope; to decrease exposure

  •  to patient’s aerosols.
  • Allow the needed time after administration of the NMBA to ensure relaxation.
  • Confirm placement of tube by visualization and EtCO2 rather than auscultation.
  • Apply viral filter prior to bagging or connection to ventilation.

Post-Intubation Management

  • Sedation and analgesia as indicated.
  • ARDS ventilation setting with smaller tidal volumes (6 ml/kg of IBW)

Post Procedure

  • Decontaminate and disinfect all airway equipment.
  • Appropriate doffing of PPE. 
  • Hand hygiene before and after all procedures.
Cite this article as: Israa M Salih, UAE, "COVID-19 Tailored RSI Bulletin," in International Emergency Medicine Education Project, July 3, 2020,, date accessed: December 5, 2023

References and Further Reading

ISAEM COVID-19 Social Media Initiative

In this post, we are sharing an announcement with you. One of our collaborators, ISAEM, is starting a new social media initiative. Here is their message.

Dear Emergency Physicians, First Responders and Front-Line Health Care Staff:

We are emailing you on behalf of the International Student Association of Emergency Medicine (ISAEM). We hope that you are staying healthy during these difficult times.

Our team is organizing a new social media initiative to share experiences from the frontline across the world during the COVID-19 pandemic in a similar style to the Humans of New York page (

We are looking for short reflections about your experience working in the emergency department and in other health care settings as well as any other thoughts you would like to share. We would also ask for a photo of yourself and/or of your current healthcare environment currently. You may submit multiple photos, but please ensure you have the permission of anyone in the photos before sending it to us. A photo consent form is provided here: 

You will be featured on the ISAEM Facebook/ Twitter accounts as well as the instagram account @humansofemerg administered by the Canadian Association of Emergency Physicians (CAEP).

You may consider responding to one of these questions, or share a different comment altogether.

  • How are things going in your ED right now (positives, challenges)?
  • How are you and your colleagues coping?
  • Do you have any advice for the general public?
  • Are there any encouraging or uplifting experiences you can share during your time working on the frontlines during the COVID-19 crisis?
  • How are you staying connected with others?

All submissions can be sent to 

We hope that this project will allow us to share candid experiences and perspectives with members of the healthcare community across the world. Thank you for considering to participate and thank you for all the work you are doing every day.



Cite this article as: iEM Education Project Team, "ISAEM COVID-19 Social Media Initiative," in International Emergency Medicine Education Project, March 30, 2020,, date accessed: December 5, 2023

The SICK in Emergency Medicine

The SICK in Emergency Medicine

Who are the SICK?

Whenever I bring my two kids to their pediatrician, there are two entrances labeled “sick kids” and “well kids”. Self-explanatory – except that both doors lead to the same shared air… so go figure.

But in emergency medicine, the word SICK takes on a very different meaning.

By SICK, we do not mean “ill” or “not-well,” “not feeling all-right,” or just having a complaint. In EM, SICK means something is very wrong with the patient, regardless of the body system affected or injured. “This particular person is sick” is how you would start your sign out to a colleague. Translation – I am actually worried about this one.

A SICK story

I was a junior resident co-managing the Trauma Bay with my senior, when among multiple other patients a middle aged man was brought in by EMS with a chief complaint of “struck by a car”. It turned out that after finishing their mutual project, a fellow handyman was backing out from the client driveway in a van and inadvertently hit his buddy. Low speed, no head injury, stable vitals and no real complaints beyond some abrasions: no problem, right?

Within 10 minutes, the patient had developed tachycardia, dumped his pressure and then became altered. “This guy is sick!” blurted by chief with some dismay, as he was already busy with several other traumas that were much more obvious. Within a minute, we had intubated the patient and activated the surgical team response. Needless to say, the FAST was very positive.

Unfortunately, the patient never made it to the OR. He coded and died in the ED before any surgical intervention could be done from what was later determined to be a massive splenic injury. No external signs for concern on the initial physical exam. It was the unlucky height of the rear bumper and the force of the van that did it.

Searching for the SICK

Hunting for the SICK remains the cornerstone of EM. Like seeping through muddy waters, we first have to find them – before “stabilizing, treating and dispositioning”, as our mandate proclaims.

Many tools are, of course, available for this task. They range from internationally accepted nursing triage scales, abnormal vitals and “scary” labs like bandemia, sky-high CRPs and lactates to sophisticated risk stratification systems. But no lab or objective score algorithm can replace your high level of suspicion, formal training, experience and clinical gestalt.

In your EM rotations, you will hopefully encounter and be taught from all of the following: high risk chief complaints (testicular pain, sudden onset headache, tearing chest pain, etc.); susceptible populations (neonates, dialysis patients, elderly, IV drug users, returning patients and so on); ominous physical exam signs (anisocoria, tongue bed elevation, extremity pallor, Cullen’s and Grey-Turner’s, abdominal rigidity, Cushing’s triad, etc.).

The hidden SICK

Not too far from the Trauma Bay within my residency’s ED resided the Behavioral Care Unit also known as the BCU. A designated holding place for patients requiring a psychiatric evaluation, the BCU was a favorite place to go to for any resident who desired to increase her productivity numbers via rapid medical clearance of multiple psychiatric holds.

Yet for many trainees, especially seniors, BCU was also a place to hunt for the SICK amongst the crazy. Many a hypoglycemia, a hyponatremia, a sepsis or a subdural hematoma were found there on numerous occasions, often with a delay from the ideal timeline.

Here are a few more phenomena to be on the lookout for:

This list is yours to expand.

Finding the SICK - it’s you and your environment

Two things –
First, as a trainee, you should always be more paranoid and suspicious of hidden pathology than your supervisors and teachers, not less so. They have the mentioned training, experience and gestalt in their arsenal, you don’t. You are thus stuck with the first item. I am often responsible for teaching newly graduated physician assistants at my work – and it really rocks my boat when I hear “I think it’s just a cold” theme from a newbie.

Second, chances are your training is currently happening at the happening place: some huge university hospital. It is currently very likely and thus very easy to find the SICK. But you are not really honing your skills for working at such places. EM life in virtually any other setting will be much more like trying to find the needle in a haystack. Think about it.

Cite this article as: Anthony Rodigin, USA, "The SICK in Emergency Medicine," in International Emergency Medicine Education Project, November 15, 2019,, date accessed: December 5, 2023

iEM in MEMC19 – Dubrovnik, Croatia

iEM in MEMC19

iEM team is attending the Mediterranean Emergency Medicine Congress 2019 in Dubrovnik Croatia. The Xth Mediterranean Emergency Medicine Congress will be held 22-25 September 2019 at the Sun Gardens Hotel. Pre-congress courses will be held on 22 September with the first full day of Congress programming beginning 23 September and running until 25 September.

In addition to attending scientific sessions, iEM team will also be interviewing with Judith Tintinalli and Melanie Stander. Interviews will be shared from platform.

Melanie Stander
Melanie Stander
Judith Tintinalli
Judith Tintinalli


The American Academy of Emergency Medicine (AAEM)  and the Mediterranean Academy of Emergency Medicine (MAEM) are two main organizers of the 2019 congress.

Pre-Congress Courses (September 22, 2019)

Scientific Program

The scientific program will be run at 6-7 different rooms with a variety of topics presented by emergency physicians joining from different countries.

lisa moreno walton

Lisa Moreno, MD MS MSCR FAAEM, AAEM President-Elect and MEMC19 Executive Chair, invites you to join us in Dubrovnik


The American Academy of Emergency Medicine designates this live activity for a maximum of 32.25 AMA PRA Category 1 Credits™.  

Cite this article as: iEM Education Project Team, "iEM in MEMC19 – Dubrovnik, Croatia," in International Emergency Medicine Education Project, September 18, 2019,, date accessed: December 5, 2023

iEM Monthly – September 2019

Welcome to the iEM Education Project Monthly Newsletter. We will share the achievements, information about top posts, chapters, activities and future plans of the project.

Hot News!

FLAME endorsed iEM

This month we received a great news from one of the regional emergency medicine organizations. Latin America Emergency Medicine Federation – Federacion Latinoamericana De Medicina De Emergencias endorsed iEM Education Project. We are looking forward to collaborate with them to improve undergraduate emergency medicine education around the globe. 


iEM will attend MEMC2019 at Dubrovnik.

The 10th Mediterranean Emergency Medicine Congress will be held 22-25 September 2019 at the Sun Gardens Hotel in Dubrovnik, Croatia. The congress is organized by American Academy of Emergency Medicine and Mediterranean Academy of Emergency Medicine.

Pre-congress courses will be held on 22 September with the first full day of Congress programming beginning 23 September and running until 25 September.

iEM will interview with Judith Tintinalli

iEM Team will interview with one of the icons of Emergency Medicine history, Judith Tintinalli during MEMC2019. 

iEM continues to meet and interview with world famous leaders of Emergency Medicine. Ian Stiel, Simon Carley, Tracy Sanson, Rob Rogers, Neil Cunningham are couple of them. You can watch or listen published episodes here.  

Judith Tintinalli

Free Emergency Medicine Clerkship iBook and pdf

iEM Free Book (2018e) reached to >3200 downloads. The book is written by 133 authors from 19 countries. It includes 106 topics, 841 pages, 454 images.

Blog Authors

There are three new blog authors joined our team in August, Bryn from USA, Sajan from Nepal and Neha from UAE. We welcome all of them. To see full blog authors team please click this link –

Bryn Dhir


Bryn Dhir is a researcher and physician-scientist, interested in Emergency Medicine residency programs. Bryn has numerous leadership and management skills for various clinical, administrative, and work initiatives around the globe.

neha 2


Neha Hudlikar is a graduate of RAK Medical & Health Sciences University and is currently training in Emergency Medicine at Zayed Military Hospital, Abu Dhabi. A big supporter of the FOAMed movement, she is passionate about developing and supporting innovative ideas that promote free access to medical education for all. Her main interests in Emergency Medicine include trauma, disaster medicine, PoCUS and development of EM in resource limited settings. She currently also serves as the Associate Editor of Emirates Society of Emergency Medicine Newsletter. Outside of medicine, an avid reader, tree-hugger and an advocate of gender equality.

Sajan Acharya


I am a medical graduate from Nepal. I am an eager supporter of FOAMed movement. I have always loved books. Medical school wanted me to read particular types, so I did. A poet at my core; I love to write about things that touch my heart. What better world to be in than medicine when you are on look out for moments that touches you. I find medicine fulfilling also because it feeds my passion for teaching.

Blog Posts

We published 12 posts during August 2019. The article “The research predicting septic shock” by Bryn Dhir was the top read article in August

Bryn Dhir
Bryn Dhir

Top Countries by Views

The iEM platform reached to 169 countries around the globe. In August, top countries by views are given below. 

iEM Content

iEM content general

iEM Website

iem webpage

iEM website is designed to provide a wide range of resources to medical students and educators. You can find all the topics of 2018 book provided by international authors, blog posts, and many details regarding iEM education project.

iEM 2018 Book in iBook and pdf formats

Download all content written by world-renowned professionals, emergency medicine education enthusiasts. It is a fantastic collaboration of all stakeholders.

2018 Book includes 106 topics, 841 pages, 454 images provided by 133 authors from 19 countries.

iEM Blog Posts

We have a wide range of blog authors from Nepal to Brazil, Canada to Sri Lanka, the USA to Tanzania. We post 2-3 times a week.

iEM Flickr Clinical Image Archive

iEM YouTube Video Archive

Tips To Writing Your Research: Introduction

Planning, implementing, and writing your research is a skill that you need to start learning at the beginning of the first year of medical school. Although many medical schools are good at medical research and publishing them, there are few examples out there aiming to teach proper research and writing skills to medical students. Therefore, students mainly gain such skills through interest and hard work.

Why is it important? Why should you know how to do research or write it? There are many good reasons, but I will mention one of them. When you graduate from medical school, you want to have a good CV representing your competencies. One of the components that many residency program directors looking for is research background and published articles if there is any. Having a research portfolio in CV is not only showing you are familiar to the basic concept of how to do research or writing it, but also indicates that you are a team member, collaborator, contributor. They evaluate you as “plus one” person to help the research activities in that department which is something they are always looking for. By the way, doing a scholar activity including research is “a must” for many structured EM residency programs around the globe. So, knowing how to write will give you a lot of comfort through your residency period too. 

Emergency Medicine is the most interesting 15 minutes of every other specialty.

Emergency Medicine (EM) provides fantastic opportunities to medical students including medical research. If you know the basics, if you have a good and active team around you or if you are rotating in an academic center, you are in the gold mine to make an incredible contribution to EM literature.

Any fool can make things bigger, more complex, and more violent. It takes a touch of genius — and a lot of courage — to move in the opposite direction.

There are many aspects of research such as design, analysis, writing, presenting. Each of them has many details to discuss, but the end point is communication with the readers and making potential improvement in our field.

If we consider our research process from start to end is appropriately done, we will have excellent material to be written.

This series aims to give some useful tips to medical students regarding preparing your manuscript, writing and publishing it. Although we may use some examples related to EM in this series, the tips apply to any area of research

Have something to say, and say it as clearly as you can. That is the only secret of style.

To start with, here is the topic list we are going to share. We will focus on each title separately. However, if you wish to add titles to this list, please write in comment section below. 

Topic List

  • How to find the right journal?

    You have to decide which journals you want to submit your research. This step is extremely important before you start writing your article.

  • Who is your reader and what they care about?

    Knowing your readers is important because it will help you to focus on what is important in your study.

  • Which section should you start writing?

    Most journals define research paper section similarly. These are: Title, Abstract, Introduction, Methods, Results, Discussion, and Conclusion. There are very useful recommendations that can facilitate your writing pace and save your time.

  • What is the logical flow in a manuscript?

    Because you want to share your findings with high clarity, the manuscript and its sections should be written coherently. This improves the understanding of your manuscript by reviewers, editors, and readers.

  • The Title

    The title is one of the important parts of your manuscript because it helps you to communicate with your readers directly. Having a good title not only helps to attract the editors, reviewers and your readers, it also helps to improve searchability, reachability of your research.

  • Introduction

    This section includes the core information about your research topic and clear explanation about your aim.

  • Methods

    The methods section should reflect your research details with full transparency. Quality of your research directly related to your method and how it has been written.

  • Results

    One of the most challenging parts of the manuscripts is result sections. Most of the readers are facing difficulty to understand this section because of the lack of knowledge of statistical analysis and their interpretation. Therefore, writing results section is critical to communicate with your readers.

  • Discussion

    This section summarizes your findings, and you compare/contrast them with up to date literature. This is the section that you highlights your core findings.

  • After your first draft, now what?

    Writing your first draft is a huge step. However, the manuscripts always need fine-tuning, especially for language and style.

  • Submission Phase

    You wrote your manuscript, and it is time to submit to the previously selected journal. In this phase, you need to think about what journal editors and reviewers want to see in your paper.

  • Importance of Cover Letter

    A cover letter is a tool that helps you to communicate and attract the editor. So, it should be written with care.

  • How to respond to reviewers?

    Responding to reviewers' comments is a critical task that you should take it seriously.

  • You have done everything, but your paper can still be rejected!

    Do not think that it is wasted time; this manuscript can be still valuable for your field.

I suggest to read this twitter feed too.

If you have topic recommendations, please write down.

Cite this article as: Arif Alper Cevik, "Tips To Writing Your Research: Introduction," in International Emergency Medicine Education Project, May 6, 2019,, date accessed: December 5, 2023

Video Interview: Tracy Sanson – Part 2

Are you ready to meet the genuine people behind the professional?

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.

Our guest is Dr. Tracy Sanson.

Dr. Sanson is a practicing Emergency Physician. She is a consultant and educator on Leadership development and Medical education and Co-Chief Editor of the Journal of Emergencies, Trauma and Shock; an Emergency Medicine international journal.

Part 2

The full interview is 10 minutes long and includes many advice on life, wellness, and our profession. We will be sharing short videos from this interview. However, the full interview was published as an audio file in our Soundcloud account. 

This interview was recorded during the EACEM2018 in Turkey. We thank EMAT.

The interview was recorded and produced by

Arif Alper Cevik

Elif Dilek Cakal

Murat Cetin

iEM Weekly Feed 12

Welcome to iEM Weekly Feed!

Sharing is caring!

With this feed, you do not miss anything. You will find all published blog posts and chapters during this week. Click the “title” or “read more” to open each page you interested in.

Discharge Communications

Discharge Communications (2023)

by Dominique Gelmann, Bret Nicks Authors Listen Introduction The process of emergency department (ED) discharge provides critical information for patients regarding the next steps of

Read More »

Shock (2023)

by Joseph Ciano Author Listen You have a new patient! A 55-year-old male enters your Emergency Department with sudden onset of shortness of breath with

Read More »

A Week Before!

What Was Hot In January?

List of Sections and Chapters

International Emergency Medicine Education Project’s ebook is “iEM for Medical Students/Interns.” It currently consist of 106 chapters written by 133 international contributors. Emergency physicians, residents,

Read More »

Abdominal Pain

by Shaza Karrar Case Presentation A 39-year-old female presented to the emergency department (ED) complaining of right-lower-quadrant (RLQ) pain; pain duration was for 1-day, associated

Read More »

Respiratory Distress

by Ebru Unal Akoglu Case Presentation A 40-year-old female with a history of diabetes mellitus presents with a complaint of 6 days cough and muscle

Read More »

Chest Pain

by Asaad S Shujaa Introduction Chest pain is one of the most common symptoms presented in the emergency department (ED), and it is worrisome because

Read More »


by Maryam AlBadwawi Introduction Shock, in simple terms, is a reduced circulatory blood flow state within the body. The inadequate circulation deprives the tissues of its

Read More »

PoCUS – RUSH Protocol

by Rasha Buhumaid Why use POCUS in undifferentiated hypotension? Hypotension is a high-risk sign which is associated with increased morbidity and mortality rate. The differential

Read More »

How to read head CT

by Reza Akhavan and Bita Abbasi For a standard approach to read head/brain computed tomography (CT) scan, one should adhere to systematic algorithms. The predefined

Read More »

Kunafa Knife and Play Dough for Ultrasound Training

Around two years ago, Prof. Abu-Zidan came with a plastic triangular shape spatula to one of our morning meetings. He said that

Alper, I found this as cheap as 30 cents each, and I bought 20 of them. There are metals too, but they are used as a Kunafa knife (Kunafa is sweet in middle east region). They are a little bit heavier. Because I want to use this in ultrasound training of 5th-year medical students, I need something light, easy to carry. What do you think?

It was not a surprise for me seeing such a sample proposed from a person who always thinks simple educational options. The process which started that day improved with the addition of play dough into the core discussions. After two years of discussions their values in ultrasound skills education, we wrote a methodology paper which accepted by World Journal of Emergency Surgery with unexpectedly valued comments by reviewers [1].

You can download this article from here.

As a bottom line, this article says there is no need for expensive simulators for ultrasound training. The tools which can be created less than 10 USD and used repeatedly can help to teach ultrasound enjoyably and effectively, especially in the limited resourced settings.

Triangular shaped Kunafa knife is the almost identical reflection of the view of the ultrasound on the screen. The thickness of the knife represents the 1 mm slice of the actual image that we see on the screen. 

Students understand the actual views and windows easily while they fan or tilt the knife. In addition to this practice, when the play dough added, the joy starts. Students create normal and pathologic anatomical samples and apply different angles with their triangular shape knife. This practice helps them to understand more about the image that they acquire on the screen. Then, real ultrasound practice follows on real patients or human models. You can imagine how it is enjoyable and effective for their learning. One of the advantages of this simple, cheap simulator is that its reusability. Less than 10 USD, but you can use it for 70-100 students during all academic year.

We found only three educational papers/posts about play dough usage for medical education. The first, Dr. Eftekhar and his group published a paper showing effective use of play dough for visualization of complicated cerebral aneurysm anatomy [2]. The second, Dr. Herur and her team published an article regarding play dough modeling of neurologic anatomy by students as an active learning tool [3]. The third, Dr. Adam Bystrzycki used this method to teach heart anatomy in the Echo in Life Support courses [4].

Yes, we enjoyed a lot while we were writing this paper. However, applying and testing it during the sessions was amazing. And, I shared the article in social media which I have no significant number of followers. However, even with this small attempt, we started to hear some feedback, recommendations, and samples shared by other groups and individuals who are using these tools.

Even one of the biggest ultrasound congresses, WINFOCUS, announced that they are going to use these simple teaching tool in their student course the first time.

These are promising news.

The chambers of the heart (Courtesy of Gregor Prosen)

As we all know, radiology and emergency medicine are the two leading specialties that implement ultrasound training into the student curriculum [5, 6]. As the iEM Education project, it is our aim to promote emergency medicine and provide free educational resources. Therefore, we just wanted to share in case you may think to use it in your ultrasound sessions.

This tool is so cheap. It can be created by anyone, anywhere, anytime. We are looking to hear more feedback from world ultrasound experts regarding the effectiveness and joy of this tool.


  1. Abu-Zidan FM, Cevik AA. Kunafa knife and play dough is an efficient and cheap simulator to teach diagnostic Point-of-Care Ultrasound (POCUS). World J Emerg Surg. 2019 Jan 8;14:1. doi: 10.1186/s13017-018-0220-3. eCollection 2019. PubMed  PMID: 30636969; PubMed Central PMCID: PMC6325793.
  2. Eftekhar B, Ghodsi M, Ketabchi E, Ghazvini AR. Play dough as an educational tool for visualization of complicated cerebral aneurysm anatomy. BMC Med Educ. 2005 May 10;5(1):15. PubMed PMID: 15885141; PubMed Central PMCID: PMC1274244.
  3. Herur A, Kolagi S, Chinagudi S, Manjula R, Patil S. Active learning by play dough modeling in the medical profession. Adv Physiol Educ. 2011 Jun;35(2):241-3. doi: 10.1152/advan.00087.2010. PubMed PMID: 21652511.
  4. Zedu Ultrasound Training Methods. Heart anatomy taught using state of the art methods. Accessed from, January 9, 2019
  5. Cook T, Hunt P, Hoppman R. (2007) Emergency medicine leads the way for training medical students in clinician-based ultrasound: a radical paradigm shift in patient imaging. Acad Emerg Med. 14(6):558-61. PubMed PMID: 17535978.
  6. Phelps A, Wan J, Straus C, Naeger DM, Webb EM. Incorporation of Ultrasound Education Into Medical School Curricula: Survey of Directors of Medical Student Education in Radiology. Acad Radiol. 2016 Jul;23(7):830-5. doi: 10.1016/j.acra.2016.02.012. Epub 2016 Apr 8. PubMed PMID: 27311803.

A 24 yo with eye injury

818 - Corneal chemical burn

A 24 years-old male presented to the emergency department with red-eye after direct contact with a chemical agent. You are the senior medical student/intern who should see the patient first.

How would you approach to this patient?

To learn more about it, read chapters below.

Read "Eye Trauma" Chapter

Read "Red Eye" Chapter

Quick Read

Chemical Injuries

Eye traumas caused by chemical substances constitute a wide spectrum ranging from corneal abrasions, which are simple burn symptoms, to serious burns that can result in permanent blindness. The most commonly encountered chemicals are cleaning materials, personal care items, and automobile chemicals. Alkaline chemical injuries are more common than acidic ones. Because acidic materials lead to coagulation necrosis and scar formation, deep penetration is restricted. Alkaline materials cause deeper wounds due to liquefaction necrosis. Burns are grouped into four grades, based upon intensity.

Chemical Burn Grades

What to do!

While the prognosis is good for grades 1 and 2, it is poor for grades 3 and 4. The first thing to do when a chemical substance contacts the eye is to irrigate it with normal saline or Ringer’s lactate solution in order to neutralize the eye’s pH. Applying a local anesthetic will relieve the patient’s pain. If care is being administered at the scene, tap water can be used for irrigation. Grade 1 and 2 injuries can be treated with antibiotics, steroids, and cycloplegic drugs. As antibiotics, preparations containing tobramycin or quinolone (ciprofloxacin, ofloxacin) can be used 4–5 times per day. Steroids decrease inflammation and prevent neutrophil activation. Grade 3 and 4 injuries may require surgical treatment.

To learn more about it, read chapters below.

Read "Eye Trauma" Chapter

Read "Red Eye" Chapter

Interview: Simon Carley

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.