A 63-year-old male presents for acute onset of headache, neck pain, and altered mental status. He has a prior history of hypertension and hyperlipidemia but recently lost his insurance and has been unable to fill his medications. As a well-informed 2nd year resident, you suspect the presence of a ruptured subarachnoid hemorrhage and arrange an expedited trip to the CT scanner. The patient’s blood pressure continues to remain elevated and you initiate an antihypertensive drip. You decide that in order to have accurate titration, you need more reliable data and decide to place a radial arterial line. However, the last two arterial lines you placed did not go according to plan! Before you start the procedure, you decide to review the procedure and some common pitfalls in placing radial arterial lines. You remember your attendings telling you during prior attempts to do things a certain way and you want to incorporate these in your practice. Problem: Arterial line placement is a common procedure in the Emergency Department, but can be challenging. Gap: There are particular microskills to master in order to successfully place an arterial line – and these skills decay over time. Most of these skills are different from placing an angiocatheter in a vein or from doing an arterial blood gas draw. Hook: Using just-in-time teaching, the learner can focus on the microskills to successfully place the arterial catheter just before performing the procedure. If just-in-time teaching is a new concept, please see read ALiEM’s post about just-in-time teaching. While this article may be read in entirety, the piece is intended to focus on the specific microskills of arterial line placement. As the teacher or learner, identify specific microskills from the procedure that … Continue reading Just-in-Time Training for Emergency Medicine Radial Arterial Line Placement