Trick of the Trade: The key to pollution is dilution

Wound care mantra: “The key to pollution is dilution.”

High-pressure irrigation best reduces the patient’s risk for a wound infection. Open fractures are unique in the ED in that they require quick, high-volume irrigation before going to the operating room for more definitive wash-out. Often times a 30 mL syringe and 18-gauge angiocatheter is too cumbersome and slow for high-volume, high-pressure irrigation.

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By |2019-01-28T23:53:51-08:00Sep 16, 2009|Tricks of the Trade|

Trick of the Trade: Peritonsillar abscess needle aspiration

peritonsillar abscess

How do you drain a peritonsillar abscess?

When evaluating a patient with a sore throat and “hot potato voice,” peritonsillar abscess (PTA) is at the top of the differential diagnosis list. As with all abscesses, the definitive treatment involves drainage of pus. This can be done either by incision and drainage or, more commonly, by needle aspiration.

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By |2019-07-02T20:50:17-07:00Sep 9, 2009|ENT, Tricks of the Trade|

Trick of the Trade: Hair apposition technique (HAT trick)

Scalp lacerations over hair-bearing areas require wound closure, usually with staples. An alternative technique is the Hair Apposition Technique, also known as the HAT trick [1, 2]. This technique provides a more cost-effective, faster, and less painful approach to scalp laceration repair. Imagine the scalp hairs as suture ties already embedded in the skin.

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By |2019-11-29T19:02:25-08:00Sep 2, 2009|Tricks of the Trade|

Trick of the Trade: Toxic sock syndrome

The olfactory nerve of an emergency physician is exposed to a broad range of smells in the Emergency Department. I’ve learned that the stinky-feet problem is a commonality amongst ED’s around the world! I call it the “toxic sock syndrome”. There are two remedies which I’ve been told of:

  • Nebulized oil of wintergreen
  • Placing a open canister of coffee grounds next to the feet (I’ve never understood this. I would imagine it would smell like stinky feet in a cafe. Plus, what a waste of coffee!)

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By |2019-01-28T23:54:04-08:00Aug 19, 2009|Tricks of the Trade|

Trick of the Trade: Needle thoracostomy

On a shift last week, we had a patient present with a spontaneous pneumothorax. Not only that, but it was a tension pneumothorax. Although the patient was hemodynamically stable, he was very uncomfortable and really short of breath. To give us more time to prepare for the chest tube, it was decided to perform a needle thoracostomy.

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By |2016-10-26T17:05:43-07:00Aug 12, 2009|Tricks of the Trade|

Sneak Peak "Trick of the Trade": Digital nerve block

The digital nerve block is common performed in the Emergency Department to provide anesthesia prior to wound closure. The digital nerves are typically accessed by injecting in the webspace on either side of the finger.

Have you had patients start to get sweaty and anxious merely at the sight of your drawing up lidocaine in the syringe? Despite your reassurance that the 18-gauge needle that you used was just to move the lidocaine into the syringe and that you’ll be using a small needle for the procedure, they don’t look very reassured. Trust is key to having the procedure go smoothly.

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By |2016-10-26T17:05:43-07:00Aug 5, 2009|Tricks of the Trade|