Trick of the Trade: Hair apposition technique (HAT trick)

Scalp lacerations over hair-bearing areas require wound closure, usually with staples. An alternative technique is the Hair Apposition Technique, also known as the HAT trick. [1, 2] This technique provides a more cost-effective, faster, and less painful approach to scalp laceration repair. Imagine the scalp hairs as suture ties already embedded in the skin.

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2016-10-26T17:05:42-07:00

Trick of the Trade: Toxic sock syndrome

The olfactory nerve of an emergency physician is exposed to a broad range of smells in the Emergency Department. I’ve learned that the stinky-feet problem is a commonality amongst ED’s around the world! I call it the “toxic sock syndrome”. There are two remedies which I’ve been told of:

  • Nebulized oil of wintergreen
  • Placing a open canister of coffee grounds next to the feet (I’ve never understood this. I would imagine it would smell like stinky feet in a cafe. Plus, what a waste of coffee!)

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2019-01-28T23:54:04-07:00

Trick of the Trade: Needle thoracostomy

On a shift last week, we had a patient present with a spontaneous pneumothorax. Not only that, but it was a tension pneumothorax. Although the patient was hemodynamically stable, he was very uncomfortable and really short of breath. To give us more time to prepare for the chest tube, it was decided to perform a needle thoracostomy.

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2016-10-26T17:05:43-07:00

Sneak Peak "Trick of the Trade": Digital nerve block

The digital nerve block is common performed in the Emergency Department to provide anesthesia prior to wound closure. The digital nerves are typically accessed by injecting in the webspace on either side of the finger.

Have you had patients start to get sweaty and anxious merely at the sight of your drawing up lidocaine in the syringe? Despite your reassurance that the 18-gauge needle that you used was just to move the lidocaine into the syringe and that you’ll be using a small needle for the procedure, they don’t look very reassured. Trust is key to having the procedure go smoothly.

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2016-10-26T17:05:43-07:00

Article review: CT irradiation exposure and risk

I’m still working on my 2009 ACEP Scientific Assembly handout for the LLSA exam test prep session (which were actually due yesterday!). Even though the conference isn’t until mid-October, the handouts are always due a few months earlier. And every year, it sneaks up on me! One of the articles I’m reviewing is about the risks of CT irradiation, published in the New England Journal of Medicine in 2007.

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2016-11-11T19:01:58-07:00

Article review: Propofol (2007 ACEP Guideline)

PropofolGiven all the recent brouhaha around propofol and Michael Jackson, I thought I would review the 2007 Annals of EM Clinical Practice Advisory paper on the use of propofol in the Emergency Department for procedural sedation. This is one of the 2009 Lifelong Learning Self-Assessment (LLSA) articles. Each year EM-board certified physicians are tested on 20 pre-selected LLSA articles to maintain eligibility for re-certification.

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2019-04-17T02:10:17-07:00