Trick of the Trade: Securing the intraosseous needle

So much attention is appropriately focused on the anatomy and technique for intraosseous needle placement. In contrast, very little attention is paid to securing the needle. Often this involves a make-shift setup which involves gauze, wraps, and/or tape. This becomes especially important in the prehospital setting where these can be easily dislodged. The following trick stems from a Twitter discussion in 2015 amongst prehospital providers, lamenting this fact.

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2019-01-28T21:40:34-07:00

May 3rd, 2016 | Critical Care/ Resus, Tricks of the Trade

By: Michelle Lin, MD

Trick of Trade: Build-it-yourself IV Fluid and Drug Administration Trainer

Simulation equipment can be rather expensive and wanting to practice fluid and drug administration does not always warrant the purchase of specialized equipment. Luckily, a simple administration trainer can be made in less than 10 minutes and only costs a few dollars (or even nothing). This is an ideal option for resuscitation training if you are already using a manikin without IV arms or an IO option. Learners can practice preparing infusions and administering fluid or preparing an injection and administering it via the syringe port. This trainer can have multiple IV cannulas in one lid and can even include an intraosseous cannula, such as an EZ-IO.

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2016-10-26T17:04:20-07:00

April 14th, 2016 | Expert Peer Reviewed (Clinical), Tox & Medications, Tricks of the Trade

By: Christoph Schroth

Trick of the Trade: Topical Tranexamic Acid Paste for Hemostasis

Tranexamic acid (TXA) can be used in a wide variety of settings in the Emergency Department for its hemostatic effects. Topical applications of TXA are commonly utilized to control minor bleeding from epistaxis, lacerations, or dental extractions.^1–3 More in-depth reviews of topical TXA can be found on R.E.B.E.L EM⁴ and The Skeptics Guide to Emergency Medicine.⁵

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2016-11-11T19:40:06-07:00

February 17th, 2016 | Heme-Oncology, Trauma, Tricks of the Trade

By: Scott Dietrich, PharmD

Trick of the Trade: Extra-oral reduction technique of anterior mandible dislocation

Anterior dislocation of the mandible is a clinical scenario that is not infrequently encountered by the ED provider and requires prompt intervention. The classic technique for reduction of the mandible requires the provider to place his/her thumbs or fingers into the patient’s mouth along the lower molars and apply force inferiorly and posteriorly. However, this technique is fraught with difficulties and inefficiencies including the following:

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2019-04-06T00:45:15-07:00

January 26th, 2016 | ENT, Tricks of the Trade

By: Kara Toles, MD

Trick of the Trade: Patient positioning for ultrasound-guided ulnar nerve block

Patients with 5th metacarpal fractures (commonly termed “boxer’s fracture”) are frequently treated in the emergency department (ED) with closed reduction and splinting. Obtaining analgesia and a successful closed reduction can often be challenging without procedural sedation. Severe swelling can make a hematoma block difficult, often resulting in inadequate analgesia. An ultrasound-guided ulnar nerve block provides a simple method to facilitate pain relief and allow for improved fracture site manipulation.

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2018-10-28T21:25:09-07:00

January 20th, 2016 | Tricks of the Trade, Ultrasound

By: Kara Toles, MD and Arun Nagdev, MD

Trick of the Trade: Isopropyl Alcohol Vapor Inhalation for Nausea and Vomiting

Your triage nurse complains of numerous patients in the waiting room complaining of nausea, retching, and emesis. They ask you “why can’t we have an antiemetic on hand in triage?” Turns out they might have had an effective antiemetic on hand, or rather in their scrub pocket the entire time. They just didn’t know about it yet.
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2019-06-18T23:12:47-07:00

December 21st, 2015 | Expert Peer Reviewed (Clinical), Gastrointestinal, Tricks of the Trade

By: Mark Culver, PharmD, BCPS

Trick of the Trade: Dermal Avulsion Injuries 2.0

This year I published a Novel, Simple Method for Achieving Hemostasis of Fingertip Dermal Avulsion Injuries in the Journal of Emergency Medicine ¹ — a technique I’ve used in my local ED for several years. In brief, this involves achieving hemostasis over a fingertip skin avulsion by using a tourniquet followed by tissue adhesive glue. After bringing the technique to press and sharing this video, I’ve received great tips from peers and subsequently refined it with some additional ideas. Thus I present for the first time on ALiEM: Dermal Avulsion Injuries 2.0.

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2016-11-11T19:39:55-07:00

November 5th, 2015 | Expert Peer Reviewed (Clinical), Trauma, Tricks of the Trade

By: Brian Lin, MD