Trick of the Trade: Tie-over dressing for scalp lacerations
Scalp lacerations are apparently a hot topic these days. This is the third post now on how to apply a bandage to a scalp laceration.
Trick of the Trade: Captain Morgan technique for hip dislocation
Relocation of a hip joint is often quite a sight to see in the ED. A commonly taught technique is the Allis maneuver (watch the first 45 seconds of the above video from the Medical College of Georgia). It has always seemed a bit precarious to me having someone stand on the patient’s bed.
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Paucis Verbis: Feedback card
Today’s Paucis Verbis card is a little different. This card focuses on helping you give talking points when giving feedback to a learner on shift. This could be a medical student or resident.
Dr. David Thompson (UCSF-San Francisco General Hospital) sent this great card to me and I thought it was too useful NOT to share. It’s handy on shift, which ultimately is the purpose of these Paucis Verbis cards. These are useful especially for senior residents, who are supervising medical students and junior residents.
This card can be used in many ways. For instance:
- Print these cards and fill it out at the end of the shift. Give to the learner.
- Pick 1-2 questions from the list below as launching points for your feedback discussion. You don’t have to overwhelm the learner by answering everyone item below. Sometimes less is more to be effective.
PV Card: End of Shift Feedback
Go to ALiEM (PV) Cards for more resources.
Video: Social Media in Medicine – What is it and why?
From LifeInTheFastLane.com‘s illustrious Dr. Mike Cadogan. These were the slides from his Social Media in Medicine talk at the recent USC Essentials Conference. It’s time more physicians get involved and join the conversations that are taking place on social media. Join now.
Trick of the Trade: Bandaging the scalp laceration
Scalp lacerations are one of the most common injuries which present to the Emergency Department. Applying a dry bandage over the staples or sutures can be a challenge because the tape just has nothing to adhere to.
We reviewed the use of tubular cotton gauze to create a beanie hat, but what should you do if you can’t find any tubular gauze? Ever since I wrote about the beanie hat trick, people in the ED have been using the tubular gauze more and we’re always out of stock whenever I look for it!
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Paucis Verbis: Acute vestibular syndrome and HINTS exam
What is your diagnostic approach to the acutely vertiginous patient?
The bottom-line question is: Is the cause peripheral or central in etiology?
In this great 2011 systematic review article in CMAJ on Acute Vestibular Syndrome (AVS), the authors review how (un)predictive elements of the history and physical exam are. By definition of AVS, symptoms must be continuous for at least 24 hours and have no focal neurologic deficits.
Frighteningly, the authors report many of the signs and symptoms (type of dizziness, hearing loss, patterns of nystagmus, Hallpike-Dix) are not as predictive as we classically are taught!
The take home point is to learn and incorporate the 3-part HINTS exam into your diagnostic approach (see bottom box on card). It is reported to be as good as a diffusion-weighted MRI for diagnosing a posterior stroke. The steps are:
- Do the horizontal head impulse test. (Normal = central cause)
- Check for directionally-alternating nystagmus movement on left and right gaze.
- Do the alternate cover test.
PV Card: Acute Vestibular Syndrome vs Stroke | The HINTS Exam
Adapted from [1]
Go to ALiEM Cards for more resources.
There is a helpful 10-minute video showing normal and abnormal HINT findings:
- Head impulse testing
- Nystagmus testing
- Testing of skew
VIDEO LINK: http://emcrit.org/misc/posterior-stroke-video/
Thanks to Dr. Brian Resler (UCSF-SFGH EM resident) for giving me the heads up about this at Followup Conference!
Reference
- Tarnutzer A, Berkowitz A, Robinson K, Hsieh Y, Newman-Toker D. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ. 2011;183(9):E571-92. [PubMed]
Trick of the Trade: Securing a peripheral IV on sweaty skin
Patients can become extremely diaphoretic with high fevers or if under the influence of PCP or a stimulant. Slippery, sweaty skin can pose a problem when securing peripheral IV’s. Adhesive tapes that are typically designed for securing these IV’s often slip off… immediately followed by the IV falling out.
How can you secure the IV … without using staples and sutures?