31 07, 2017

Trick of the Trade: DIY Squirt Bottle Wound Irrigation

2017-07-30T14:37:24+00:00

wound irrigationWound irrigation is arguably one of the most important steps in closing a laceration, because all lacerations should be considered to be contaminated. Irrigation is considered the foundation in preventing infection. A common way to cleanse a wound is to irrigate a wound using a 20 cc syringe, angiocatheter, and splash protector. To achieve 500 cc of irrigation, however, it would require 25 syringe refills! Is there a better, cost-effective alternative?
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26 07, 2017

Trick of the Trade: Gaze Testing Using “Selfie Mode” on Your Smartphone Camera

2017-07-26T10:35:49+00:00

gaze testingThe NIH Stroke Scale is used to assess the severity of a suspected stroke. It includes 11 neurologic exam components that can be quickly performed at the bedside. The second component of the NIH Stroke Scale is testing of voluntary horizontal eye movements, a.k.a., “best gaze”.1 Gaze is usually tested by instructing the patient to follow the examiner’s hand or pointer finger in a horizontal plane from side to side. This assessment assumes that the patient can comprehend instructions and actively participate in the physical exam.

But… how do you test gaze if your patient is aphasic or unable to follow commands?
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4 06, 2017

Trick of the Trade: Using Linear Transducers for Point of Care Ultrasound in Intrauterine Pregnancy Evaluation

Ultrasound Intrauterine PregnancyThe volume of women presenting to the emergency department (ED) with newly diagnosed first-trimester pregnancies and suspected ectopic pregnancies sometimes seems like an infinitely growing number. As ED physicians, proper identification of an intrauterine pregnancy (IUP) in these patients is of paramount importance and the initial imaging test of choice for many has become bedside point-of-care ultrasound (POCUS).

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4 06, 2017

Trick of the Trade: Linear Transducers for Point of Care Ultrasound in Intrauterine Pregnancy Evaluation

2017-07-19T00:05:47+00:00

Ultrasound in Intrauterine PregnancyThe volume of women presenting to the emergency department (ED) with newly diagnosed first-trimester pregnancies and suspected ectopic pregnancies sometimes seems like an infinitely growing number. As ED physicians, proper identification of an intrauterine pregnancy (IUP) in these patients is of paramount importance and the initial imaging test of choice for many has become bedside point-of-care ultrasound (POCUS).

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4 06, 2017

Trick of the Trade: Using Linear Transducers for Point of Care Ultrasound in Pregnancy Evaluation

2017-06-04T21:05:28+00:00

Ultrasound Intrauterine PregnancyThe volume of women presenting to the emergency department (ED) with newly diagnosed first-trimester pregnancies and suspected ectopic pregnancies sometimes seems like an infinitely growing number. As ED physicians, proper identification of an intrauterine pregnancy (IUP) in these patients is of paramount importance and the initial imaging test of choice for many has become bedside point-of-care ultrasound (POCUS).

(more…)

22 03, 2017

Trick of the Trade: Sphenopalatine Ganglion Block for Treatment of Primary Headaches

2017-03-25T04:09:50+00:00

It is thought that the autonomic nervous system is likely involved in migraines and other primary headache disorders given commonly associated symptoms such as nausea, lacrimation, emesis, and rhinorrhea. The sphenopalatine ganglion (SPG) is an extracranial parasympathetic ganglion with both sensory and autonomic fibers. It has therefore been hypothesized that blockade of the sphenopalatine ganglion may produce relief from primary headaches by modulating the autonomic fibers involved in headache disorders.1

While in our anecdotal experience with SPG blocks has been overall very positive, thus far there have been only a few small studies that have investigated it’s use in the Emergency Department. The currently available evidence has been mixed.

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13 02, 2017

Trick of the Trade: Rapid Insertion of Orogastric Tube

2017-02-10T05:43:11+00:00

We have all been in the situation: an intubated patient needs an orogastric (OG) tube and no one has been able to place it successfully. Unfortunately, we typically find out about this situation after several failed attempts, when the patient is bleeding and/or the anatomy is distorted. It may coil in the mouth or esophagus. Here I present a novel technique to rapidly place an OG tube within seconds.
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