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.

By |2019-02-19T18:53:55-08:00Mar 3, 2010|Tricks of the Trade|

iPhone uses in the Emergency Department

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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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By |2016-11-11T19:01:35-08:00Feb 18, 2010|Social Media & Tech, Tricks of the Trade|

Trick of the Trade: My new penlight

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On any given day in the ED, I use my super-bright penlight 2-5 times a day. It is amazing what things I’ve almost missed without a bright LED flashlight.

  • Subtle HSV-2 labial ulcerations in a female patient with dysuria
  • Additional scalp lacerations hidden in the hair
  • Tonsillar exudates in a patient with strep pharyngitis
  • Unequal pupillary responses in a brightly lit trauma room in a head-injured patient

I wanted to revisit a prior post about the importance of changing your Tungsten penlight to a LED light.

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By |2019-01-28T23:47:58-08:00Feb 17, 2010|Tricks of the Trade|

Trick of the Trade: Preventing tissue adhesive seepage

Dermabond Tape

As great as tissue adhesives are in wound closure, they come with some risk. For instance, liquid adhesives, such as Dermabond, can “run” and contact undesired areas such as eyelid margins. Careful application of tissue adhesives is critical.

How can you minimize the amount of seepage of tissue adhesive to undesired areas?

Trick of the Trade

Create an impermeable tape barrier

I already mentioned this in an earlier post in July, but I now have more experience with this technique. Here are some recent photos of this trick in action.

  • Cut out a circle from a transparent tape adhesive. In this case, I used a transparent Tegaderm which can be found with peripheral or central line IV kits.
  • Adhere the tape to the patient’s skin primarily along the circular edge to prevent glue seepage under the tape. You don’t need to stick the ENTIRE transparent tape to the patient, unless you want to pull off some eyebrow and eyelid lashes!
  • Apply the tissue adhesive glue over the wound while ensuring that the wound edges are closely approximated. Excess glue will run off onto the tape. You only need to wait a few seconds after glue application before peeling the tape off.
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DermabondTapeTrick10blursm

This idea was contributed by Dr. Hagop Afarian (UCSF-Fresno).

Thanks also to my Visual Aid Project photographer, Lourdes Adame, who photographed and consented the patient’s father for these photos. Her speaking fluent Spanish made them feel at ease and understand that we were photographing for educational purposes.

By |2019-02-04T03:35:20-08:00Feb 3, 2010|Tricks of the Trade|

Trick of the trade: Irrigating scalp lacerations

Laceration_Scalp1smThanks to my new-found Emergency Medicine friend in Turkey, Dr. John Fowler has some useful tips about scalp lacerations.

Often patients with scalp lacerations have clotted blood in their hair. While we can irrigate the wound itself (and unavoidably soaking the patient in cold irrigation fluid), a lot of blood remains stuck in their hair. It would be nice if we could completely wash out the blood. This would further allows us to detect occult scalp lacerations.

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By |2019-02-19T18:48:05-08:00Jan 27, 2010|Tricks of the Trade|