Trick of the trade: Irrigating scalp lacerations

Laceration_Scalp1smThanks to my new-found Emergency Medicine friend in Turkey, Dr. John Fowler has some useful tips about scalp lacerations.

Often patients with scalp lacerations have clotted blood in their hair. While we can irrigate the wound itself (and unavoidably soaking the patient in cold irrigation fluid), a lot of blood remains stuck in their hair. It would be nice if we could completely wash out the blood. This would further allows us to detect occult scalp lacerations.

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2019-02-19T18:48:05-07:00

Paucis verbis card: The Red Eye

Here is another installment of the Paucis Verbis (In a Few Words) e-card series on the topic of The Red Eye from EM Clinics of North America.

Here are some images:

Keratoconjunctivitis

Epidemic keratoconjunctivitis (note subtle white precipitates over pupil)

BacterialConjunctivitis

Bacterial conjunctivitis (note injection along inferior fornix)

Episcleritis

Episcleritis

Scleritis

Scleritis (note bluish hue of deep scleral vessels)

Glaucoma

Acute angle closure glaucoma (note corneal edema)

PV Card: The Red Eye


Go to the ALiEM Cards site for more resources.

2019-01-28T23:45:55-07:00

Trick of the Trade: Modified hair apposition technique

smHATtrick1

I got a nice email from Dr. John Fowler from Turkey who recently published a modified version of the Hair Apposition Technique (HAT) trick in the American Journal of Emergency Medicine in 2009.

Read more about the traditional HAT trick.

The HAT trick allows for scalp laceration closure by using scalp hair and tissue adhesive glue. Contraindications to this technique for wound closure include hair strands less than 3 cm, because it is difficult to manually manipulate short hair.

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2019-02-19T18:54:15-07:00

Paucis Verbis card: Supratherapeutic INR

What do you do in these cases?

  • A man on coumadin for atrial fibrillation arrives because he has increased bruising on his skin. He is otherwise asymptomatic. He was told to come to the ED because of a lab result showing INR = 6.
  • A woman on coumadin for atrial fibrillation arrives because of melena and hematemesis. She looks extremely sheet-white pale. Her vital signs are surprising normal. Stat labs show a hematocrit of 15 and an INR value that the lab is “unable to calculate” because it is so high.

Updated on 6/1/13: Old PV card revised to reflect the 2012 ACCP guidelines

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2017-03-05T14:14:35-07:00

Trick of the Trade: Pediatric Distractors

Remember back in the day when we made simple toys for pediatric patients to focus on during the physical exam? Remember the inflated medical glove +/- a face drawn on it?

I just encountered a FREE iPhone application (Eye Handbook), which has a lot of useful features. I currently only use the Pediatric Fixation animations. They can be found under the “Testing” section. Kids (and often adults too!) become mesmerized and distracted by the cartoon animations.

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2019-01-28T23:45:44-07:00

Trick of the Trade: Finger nailbed laceration repair

LacFingernailsmOver the years, I have been frustrated by how inelegant finger nailbed closure is. Nailbed lacerations are often sustained by a major crush injury, resulting in a stellate and irregular laceration pattern. This typically also requires the crushed fingernail to be removed. Cosmesis is never ideal because pieces of the nailbed are often missing, as seen in the photo above.

Occasionally, nailbed lacerations are caused by a cutting rather than a crush mechanism. In these cases, I use a different technique. I leave the fingernail on. In fact, I use the fingernail to help reapproximate the nailbed edges.

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2016-11-11T19:01:44-07:00