Trick of the Trade: Pelvic speculum for peritonsillar abscess

PTA 1 LabeledPeritonsillar abscess drainage in the ED continues to be one of my favorite procedures to perform. There are several tricks to increase your chances for a successful aspiration. One trick involves using a curved laryngoscope to help depress the tongue AND provide a bright light source.

What if you don’t have a laryngoscope readily available?


By |2019-01-28T23:36:17-08:00Mar 20, 2012|ENT, Tricks of the Trade|

Trick of the Trade: Irrigation fluid is key – but not in your eye!

High pressure irrigation of wounds is critical in reducing the rate of wound infection. There are a variety of commercial irrigation kits which include splash guards. If you are irrigating correctly and generating at least 8 PSI of pressure, some irrigation fluid should splash up and out of the wound. Be careful not to splash irrigation fluid in your eyes.

What if you don’t have a commercial irrigation setup? 


By |2019-02-19T18:07:59-08:00Mar 13, 2012|Tricks of the Trade|

Trick of the Trade: Another magnet trick for metallic FB removal


Last week, I talked about the use of Rare Earth Magnets for removing metallic foreign bodies. Sometimes a straight magnet though isn’t quite strong enough to grab a metallic foreign body. If only you had a small magnetic hemostat.

This week Dr. Catherine Perry (Culpepper Memorial Hospital) and Dr. Kolapo DaSilva (PGY-2 at UVA) emailed me with a creative solution. They encountered a patient with a BB pellet lodged deeply in the soft tissue. Small mosquito clamps couldn’t get around the BB. A cardiac magnet alone caused the BB to tent the skin up.


By |2019-01-28T22:25:49-08:00Mar 6, 2012|Tricks of the Trade|

Trick of the Trade: Difficult intubation — making lemonade out of lemons


IPoolBloodn many cases of massive GI bleeding, airway control is essential. During endotracheal intubation, suction sometimes just isn’t adequate enough to allow to get a good view of the vocal cords. The pool of blood keeps re-accumulating faster than you can suction. You think you see an arytenoid, pointing you in the direction of the trachea, and so you slide the endotracheal tube in.

Unfortunately, when you bag the patient, you realize that you are in the esophagus.



By |2016-11-11T18:51:16-08:00Jan 31, 2012|Tricks of the Trade|

Trick of the Trade: Minimizing propofol injection pain

Propofol“Ow, that burnnnnssss… ow! ow! ow! … zzzzzz…

As many as 60% of patients report significant pain with the injection of IV propofol. Once a patient experiences pain, it’s too late to reverse it. Often all you can do is to tell them that the pain will subside in a few seconds. What can you do preemptively to minimize the pain of propofol injection?


By |2019-01-28T22:23:58-08:00Jan 24, 2012|Tox & Medications, Tricks of the Trade|

Trick of the Trade: Dental Avulsion and Subluxation

It’s a Friday evening shift in the “minor area” of your ED and a young woman who had imbibed a little too much alcohol comes in with an avulsion of her first left upper incisor after falling and striking her face against the ground.  She’s crying because of the event but is otherwise unscathed.  At this point it’s time to take care of the avulsion.  What to do? (see PV Card on ED Treatment of Dental Trauma)


By |2016-11-11T18:51:18-08:00Jan 17, 2012|Dental, Tricks of the Trade|
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