Trick of the trade: Endotracheal tube lubrication

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Does your endotracheal tube get caught up on a swollen or floppy epiglottis during insertion?

Trick of the Trade: Endotracheal tube lubrication

Occasionally the endotracheal tube may become “caught up” along the epiglottis. Because it is difficult to predict when this may happen, pre-lubricate the endotracheal tube cuff and tip with a thin layer of water-soluble lubricant, such as K-Y jelly. This lubricant can also minimize the degree of surface trauma to the trachea and tracheal rings as the tube passes the vocal cords.

2016-11-11T19:00:45-07:00

Trick of the trade: Percuss the spine in low back pain

 SpineAnatomysmMany patients present to the Emergency Department for low back pain. Determining whether these patients have a red-flag diagnosis can be difficult. Red flag diagnoses include:

  • Fracture
  • Cauda equina syndrome/ spinal cord compression
  • Spinal infection
  • Vertebral malignancy

Almost all patients presenting with back pain, whether it be a muscle spasm or a spinal epidural abscess, will have back tenderness to some extent. So, how can you better differentiate benign from dangerous etiologies?

(more…)

2016-11-11T19:01:21-07:00

Trick of the Trade: Retracting Swollen Eyelids

EyelidRetractorsmEyelids can become edematous from blunt trauma and local inflammation, making it difficult to visualize the orbit. How do you retract the eyelids, if you don’t have the fancy ophthalmology eyelid retractors?

Trick of the Trade

Use a Q-tip

I thought of this idea when I was rolling up a projector screen in a conference room. Why can’t we use this rotational concept on the upper eyelid to retract it? Rest the Q-tip on the surface of the upper eyelid and slowly rotate the Q-tip to “roll” the eyelid out of the way.

ScreenRollerBelow are a series of photos of a woman with eyelid swelling from conjunctivitis. This technique provides a relatively painless way to retract the eyelid without placing pressure on the orbit itself. Although the images look like I am merely lifting the eyelid using the Q-tip, I am actually twirling the Q-tip.

 Eyelid Roll
Consent and photographs taken by Lourdes Adame
(Visual Aid Project member)
2019-01-28T23:42:58-07:00

Trick of the trade: Eye irrigation setup

MorganLensMorgan lens are placed to irrigate eyes splashed with foreign substances. Whenever I place them, images of horror and torture movies arise. Especially for patients who aren’t used to having something touch their eyes like contact lens, the Morgan lens gives them the heeby-jeebies.

For the past several years, I’ve stopped using Morgan lens and have started using something that all Emergency Departments have — nasal cannulas for oxygen administration. They are perfect for high-volume eye irrigation.

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  • Instead of attaching the nasal cannula to an oxygen port, attach it to the end of IV tubing, which in turn is attached to a 1 liter normal saline bag. The IV tubing fits snuggly into the nasal cannula tubing.

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  • Rest the nasal cannula prongs over the patient’s nasal bridge to irrigate the eyes.
  • Then open up the flood gates!
  • To avoid a huge deluge of fluid onto the patient and floor, be sure to have a way to catch the fluid. Some place multitudes of towels around the patient’s head to absorb the fluid.
  • As an alternative solution to towels, I like Dr. Stella Yiu’s (Univ of Toronto) adaptation of my cut-out basin approach for irrigating scalp wounds. To avoid overflow spillage, she rests a Yankauer suction tip at the bottom of the basin to collect the irrigation fluid.

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2019-02-19T18:53:53-07:00