Trick of the Trade: DIY Squirt Bottle Wound Irrigation

Wound irrigation is arguably one of the most important steps in closing a laceration, because all lacerations should be considered to be contaminated. Irrigation is considered the foundation in preventing infection. A common way to cleanse a wound is to irrigate a wound using a 20 cc syringe, angiocatheter, and splash protector. To achieve 500 cc of irrigation, however, it would require 25 syringe refills! Is there a better, cost-effective alternative?
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By Adam Kaye, MD|2017-07-30T14:37:24-07:00Jul 31, 2017|Orthopedic, Trauma, Tricks of the Trade|

Trick of the Trade: Gaze Testing Using “Selfie Mode” on Your Smartphone Camera

The NIH Stroke Scale is used to assess the severity of a suspected stroke. It includes 11 neurologic exam components that can be quickly performed at the bedside. The second component of the NIH Stroke Scale is testing of voluntary horizontal eye movements, a.k.a., “best gaze”.¹ Gaze is usually tested by instructing the patient to follow the examiner’s hand or pointer finger in a horizontal plane from side to side. This assessment assumes that the patient can comprehend instructions and actively participate in the physical exam.

But… how do you test gaze if your patient is aphasic or unable to follow commands?
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By Katie Stiene|2017-07-26T10:35:49-07:00Jul 26, 2017|Neurology, Tricks of the Trade|

Trick: Linear Ultrasound Transducers in Intrauterine Pregnancy Evaluation

The volume of women presenting to the emergency department (ED) with newly diagnosed first-trimester pregnancies and suspected ectopic pregnancies sometimes seems like an infinitely growing number. As ED physicians, proper identification of an intrauterine pregnancy (IUP) in these patients is of paramount importance and the initial imaging test of choice for many has become bedside point-of-care ultrasound (POCUS).

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By Amy Phillips, MD|2019-11-10T21:32:28-08:00Jun 4, 2017|Ob/Gyn, Tricks of the Trade, Ultrasound|

Trick of the Trade: Sphenopalatine Ganglion Block for Treatment of Primary Headaches

It is thought that the autonomic nervous system is likely involved in migraines and other primary headache disorders given commonly associated symptoms such as nausea, lacrimation, emesis, and rhinorrhea. The sphenopalatine ganglion (SPG) is an extracranial parasympathetic ganglion with both sensory and autonomic fibers. It has therefore been hypothesized that blockade of the sphenopalatine ganglion may produce relief from primary headaches by modulating the autonomic fibers involved in headache disorders.¹

While in our anecdotal experience with SPG blocks has been overall very positive, thus far there have been only a few small studies that have investigated it’s use in the Emergency Department. The currently available evidence has been mixed.

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By Jeffrey Shih, MD, RDMS|2019-05-06T21:21:41-07:00Mar 22, 2017|Neurology, Tricks of the Trade|

Trick of the Trade: Rapid Insertion of Orogastric Tube

We have all been in the situation: an intubated patient needs an orogastric (OG) tube and no one has been able to place it successfully. Unfortunately, we typically find out about this situation after several failed attempts, when the patient is bleeding and/or the anatomy is distorted. It may coil in the mouth or esophagus. Here I present a novel technique to rapidly place an OG tube within seconds.
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By Paul Willette, DO, FACEP|2018-10-28T21:30:59-07:00Feb 13, 2017|Critical Care/ Resus, Tricks of the Trade|

PEM Pearls: Calming techniques while repairing a laceration

Most children who come into the Emergency Department present with pain or experience pain during their ED stay.¹,²,³ Pain and distress during a procedure can leave a lasting impact on a child and contribute to mistrust of the medical system and compliance with future procedures.¹ ,⁴,⁵ Children who use active forms of coping report less pain and distress during a procedure.³ To help with coping, when feasible, involve parents or family, nursing and a child life specialist. If the parents are willing, try to get them involved in all parts of the medical procedure.²,³ This includes positioning the patient with a parent in a secure parental-hugging hold or maintaining close physical contact throughout the procedure.⁶ This can easily replace immobilization of a child or the use of restraints which can cause increased fear and escalate the degree of anxiety in a child.²

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By Ashley Foster, MD|2019-02-19T18:54:16-08:00Feb 7, 2017|Pediatrics, PEM Pearls, Trauma, Tricks of the Trade|

Trick of the Trade: Warfarin tablet strength identification

Medical providers commonly encounter patients in the emergency department who state they are anticoagulated with warfarin, but they have no idea what dose they are taking. “I know that I take two pills of warfarin daily.” Dosing becomes critically important especially when continuing their medication as an inpatient, refilling their medications, or adjusting their outpatient dose because of an inappropriately high or low INR level. How can you determine the patient’s warfarin dose?
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By Samantha Boartfield, PharmD|2017-01-05T23:13:52-08:00Dec 30, 2016|Tox & Medications, Tricks of the Trade|

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