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. The July 2023 podcast talks nicely about why knowing the HALO procedures is so essential – have a listen!

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

Non RCEMResources on Transvenous Pacing – should we be doing this in ED? We’re proficient. Tips from J Emerg Med 2006 here and here.

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!

Resources:
Reference on Basic Airway Management and e-learning here
Reference on Difficult Airway Management with e-learning here.
Reference on RSIs and blog on assisting with RSIs.
SAQs on trachys, the emergency surgical airway, difficult airway


Non RCEM Resources:
Cric from Anatomy for EM Ireland.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!

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.

Resources:
Resuscitative Hysterotomy (perimortem c-section), Reference section, learning session

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?

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.

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.

Paediatric Sedation

Curriculum says Observed DOPS

Simulation:
Your resus department will have paediatric mannikins.

Pericardiocentesis

Curriculum says sim.

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.

Resources:
We’re waiting for some resources on this. If you could write them or signpost, please let us know!

Fractures and Splinting

Curriculum says supervised splinting and DOPS of: Shoulder, Elbow, Wrist, Finger, Hip, Femur, Lower leg, Ankle, Toes, Mandible

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.

Resources:
FIB module

Lumbar Puncture

This is on the ACCS competency list.

Simulation:
You can get mannikins for this – does anyone have recommendations?

Resources:
This could be the module that you write!

Setting up Central Lines and ART Lines

This is on the ACCS Competency list.

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!

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