Trick of the Trade: Avoiding a straight-needle needlestick injury

StraightNeedleYou are finishing up a successful subclavian line procedure. You insert the straight-needle suture needle through the skin to secure the line. When trying to pull it out, you accidentally poke yourself!

This is actually a common scenario for a needlestick injury. Although many central line kits now have curved suture needles, many still have straight needles. How can you avoid a needlestick?



Trick of the Trade: Don’t miss the pneumothorax in needle thoracostomy

PTXtensionA patient arrives in PEA arrest and you note that her left chest has no breath sounds or lung sliding on bedside ultrasound. You suspect a tension pneumothorax.

You insert a standard 14g angiocather in the left 2nd intercostal space (ICS). You don’t hear a rush of air. The patient’s clinical condition deteriorates to impending asystole. How sure are you that your angiocatheter actually reached the pleural space?



Tricks of the Trade: Calcium gel for hydrofluoric acid burns

HydrofluoricAcidA 41 y/o m presents to your ED after an occupational exposure to 30% hydrofluoric acid (HF). The thumb and index finger of his right hand were affected. Upon visual examination, the site of exposure looks relatively benign but the patient is complaining of extreme pain. Beyond giving opioids, what can you do?