Tricks of the trade: Anesthetizing the nasopharyngeal tract

Nasogastric tube placement is one of the most uncomfortable procedures in the Emergency Department. Why can’t we find a painless way to do this?

Now that I am doing more fiberoptic nasopharyngoscopes, this issue is coming up more and more frequently. I’ve been using NP scopes mainly to check for laryngeal edema in the setting of angioedema. These recent photos visualize a normal epiglottis and normal laryngeal anatomy, respectively.

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2016-11-11T19:01:27-07:00

Trick of the trade: Ear foreign body extraction

BeadsA 6-year old boy has placed a hard bead in his ear and presents to the ED for care. How do you remove this foreign body as painlessly as possible? You can just barely see the edge of the bead by just looking at the external ear.

By experience, you know that mini-Alligator clips and forceps will not be able to sufficiently grab the edges of the bead. Additionally it may push the bead in even further.

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2019-02-19T18:08:04-07:00

Tricks of the trade: Chemical sedation options

 DilatedPupilsmYou walk into a room where a patient is screaming and thrashing about in his/her gurney from some stimulant abuse. PCP, cocaine, methamphetamine… or all of the above.

When the number of people (police officers, security guards, nurses) is greater than the patient’s pupil size, you KNOW that you’ll need some chemical sedation.

What intramuscular sedation regimen do you use?

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2016-11-11T19:01:31-07:00

Trick of the trade: Irrigation scalp wound photos

I mentioned from an earlier post about building a “head basin” for collecting irrigation fluid prior to wound closure. This basin prevents a deluge of fluid from soaking the gurney sheets and patient.

I finally managed to capture this trick in action, while a student was irrigating an eyebrow laceration.

Pearl

When cutting out a semi-circular or rectangular hole in the basin, be sure that there remains a 2-4 inch lip at the bottom to ensure that fluid can collect in the basin.

2019-02-19T18:53:55-07:00

Trick of the trade: Spicing up your evidence-based lecture

JournalClubsmBefore I start creating a new talk, I ask myself 3 questions:

  1. Who will be in the audience?
  2. How can I make my talk more worthwhile to audience members, beyond their just reading the material/handout/articles on their own?
  3. Am I giving a talk before or after Dr. Amal Mattu? If so, just be resigned to being second-best.

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2019-02-19T18:55:41-07:00

iPhone uses in the Emergency Department

EMnewssm
Occasionally, I get a rare – “Hey congrats on the article!” comment from residents or students. It’s usually in reference to my ACEP News column that comes out every 3 months on Tricks of the Trade. However, I got about 3 shout-outs in the past 2 days. How odd.

Then I saw one of our office staff who was reading EM News. “Hey cool!” she said. Totally confused, I realized that I was quoted on the front page of this week’s publication about iPhone applications in EM. Many months ago, I had done a brief telephone interview with the writer.

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2016-11-11T19:01:35-07:00