Performing a two layer wound closure can be a challenging procedure in the Emergency Department for clinicians with limited wound care experience. Challenges include suture choice, suture placement, and the technique of burying the knot in the deep layer of the wound, and the availability of ready ‘volunteers’ with complex wounds willing to let novices practice on them. Commercially available suture models are expensive, and can be cumbersome to store, and difficult to obtain in a timely manner to provide the learner with opportunities to practice prior to wound repair on a patient in the department.
Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this peer-reviewed case series, we focus on real clinical cases where bedside ultrasound changed management or aided in diagnoses. In today’s case, a 74-year-old woman presents to the Emergency Department with painful right arm paresthesias.
You are resuscitating a hypotensive patient with severe sepsis and have just hung your 4th liter of crystalloid. On the fluid bags, you wrote the numbers 1 through 4 in permanent marker to help keep track of your resuscitation. As you finish placing your central line the charge nurse enters the room. He informs you that according to the Institute for Safe Medical Practices (ISMP), writing directly on IV bags with permanent marker is not recommended due to concerns that the ink will leach into the bag and potentially cause harm to your patient.1–4
This situation raises several questions:
- Should we write on IV bags in permanent marker?
- Is there a possibility of ink diffusing through polyvinylchloride (PVC) bags?
- If so, is there potential harm to the patient?
Have you heard of the Pediatric Assessment Triangle? Taught in the Pediatric Education for Prehospital Professionals (PEPP) certification course, it provides a clear and simple approach to the emergency assessment of pediatric patients. The following PV card summarizes the PAT:
PV Card: Pediatric Assessment Triangle
Adapted from 
Go to ALiEM (PV) Cards for more resources.
- Dieckmann R, Brownstein D, Gausche-Hill M. The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatr Emerg Care. 2010;26(4):312-315. [PubMed]