Amazing video: Awake endotracheal intubation

Videos are priceless when trying to teach procedures. This amazing teaching video by Dr. Michael Bailin at Mass General demonstrates a novel way of anesthetizing the airway during an awake intubation.

Inject 3 cc of lidocaine using a small butterfly needle through the cricothyroid membrane. This causes coughing, which spreads the lidocaine throughout the upper airway.
Inject 5 cc of atomized lidocaine through the fiberoptic scope port to anesthetize the posterior oropharynx and vocal cords.
Slide the endotracheal tube over the fiberoptic scope.

(more…)

By Michelle Lin, MD|2019-01-28T23:43:42-08:00Apr 8, 2010|Medical Education|

Trick of the trade: Eye irrigation setup

Morgan lens are placed to irrigate eyes splashed with foreign substances. Whenever I place them, images of horror and torture movies arise. Especially for patients who aren’t used to having something touch their eyes like contact lens, the Morgan lens gives them the heeby-jeebies.

For the past several years, I’ve stopped using Morgan lens and have started using something that all Emergency Departments have — nasal cannulas for oxygen administration. They are perfect for high-volume eye irrigation.

Instead of attaching the nasal cannula to an oxygen port, attach it to the end of IV tubing, which in turn is attached to a 1 liter normal saline bag. The IV tubing fits snuggly into the nasal cannula tubing.

Rest the nasal cannula prongs over the patient’s nasal bridge to irrigate the eyes.
Then open up the flood gates!
To avoid a huge deluge of fluid onto the patient and floor, be sure to have a way to catch the fluid. Some place multitudes of towels around the patient’s head to absorb the fluid.
As an alternative solution to towels, I like Dr. Stella Yiu’s (Univ of Toronto) adaptation of my cut-out basin approach for irrigating scalp wounds. To avoid overflow spillage, she rests a Yankauer suction tip at the bottom of the basin to collect the irrigation fluid.

By Michelle Lin, MD|2019-02-19T18:53:53-08:00Apr 7, 2010|Ophthalmology, Tricks of the Trade|

Joining the Research Blogging community

Yesterday, I posted a review of an Academic Medicine education article on how to prepare medical students for their clinical clerkships, based on the Kolb learning cycle model. My blog post is now also linked and searchable from the Research Blogging network at http://researchblogging.org. Thanks to Life in the Fast Lane, who told me about the site.

(more…)

By Michelle Lin, MD|2019-01-28T23:43:54-08:00Apr 6, 2010|Social Media & Tech|

Article review: Preparing for clinical clerkships during medical school

Do you remember the sheer terror you felt, when you first started your medical school clinical rotations? Your first two years were probably spent in classrooms and small-group labs discussing anatomy, pharmacology, pathology, etc.

Then BAM! You are thrown into the deep end of the pool. You are now on a clinical team of medical professionals taking care of actual patients!

(more…)

By Michelle Lin, MD|2016-11-11T19:01:26-08:00Apr 5, 2010|Education Articles, Medical Education|

Paucis Verbis card: ABG interpretation

I have yet to find a better arterial blood gas interpretation review article than the 1991 Western Journal of Medicine summary by Dr. Rick Haber.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews ABG Interpretation. The recent addition of an ABG machine in our ED has made a tremendous difference in our ability to care for undifferentiated patients. This is a refresher in making heads and tails of mixed acid-base disorders.

Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

Haber R. A practical approach to acid-base disorders. West J Med. 1991;155(2):146-151. [PubMed]

By Michelle Lin, MD|2021-10-19T18:53:19-07:00Apr 2, 2010|ALiEM Cards, Endocrine-Metabolic, Pulmonary|

What do you do with old posters?

In academia, it is common practice to make posters of your abstracts for national conferences. Once you are done presenting, what DO people do with the posters? I have several posters rolled up in my garage collected over the years.

If the answer is nothing, why can’t we find a more creative way to display static (or even video) content during abstract sessions? Perhaps use a large LCD screen instead of posters taped to a backboard?

(more…)

By Michelle Lin, MD|2016-11-11T19:01:27-08:00Apr 1, 2010|Medical Education|

Tricks of the trade: Anesthetizing the nasopharyngeal tract

Nasogastric tube placement is one of the most uncomfortable procedures in the Emergency Department. Why can’t we find a painless way to do this?

Now that I am doing more fiberoptic nasopharyngoscopes, this issue is coming up more and more frequently. I’ve been using NP scopes mainly to check for laryngeal edema in the setting of angioedema. These recent photos visualize a normal epiglottis and normal laryngeal anatomy, respectively.

(more…)

By Michelle Lin, MD|2016-11-11T19:01:27-08:00Mar 31, 2010|Tricks of the Trade|

About Michelle Lin, MD

Reference