Trick of the Trade: Pediatric video laryngoscope for ear foreign bodies

It is near the end of your shift and one of the nurses asks you to see a fellow ED staff member’s nine-year old daughter who has accidentally put a foreign body into her ear. You go see her and the otoscope reveals a small shiny jewel within the ear canal however flushing does not work to get it out. Next you try using the otoscope, while exposing the ear canal and holding the forceps to grasp the object. Unfortunately, it is difficult to get your assistant to align the light, and the otoscope speculum is limited in view and access.

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2016-11-11T19:35:39-07:00

November 26th, 2014 | ENT, Tricks of the Trade

By: Yen Chow, MD CCFP

Trick of the Trade: Insect removal from the ear

Insect removal from the ear is a foreign body removal procedure with unique considerations. First, insects are friable. Have you ever squashed a house centipede? It’s like their 700 legs are spring-loaded to fall off instantly when touched. This characteristic makes mechanical removal by alligator forceps or cerumen loops less reliable. Second, they are alive which means they can move during your attempted extraction procedure.

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2017-05-06T20:32:25-07:00

October 2nd, 2014 | ENT, Tricks of the Trade

By: Mitchell Li, MD

Trick of the Trade: V-to-Y flap laceration repair for tension wounds

You see a patient with a large V-shaped laceration under tension requiring suture repair. Resist the temptation to simply pull the edges together and close the laceration with simple interrupted or running sutures. Excessive tension on a flap edge during the healing process can compromise its blood supply. This causes ischemia to the healing tissue, which in turn makes that flap edge more likely to dehisce, necrose, and become infected.

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2016-11-11T19:22:28-07:00

August 16th, 2014 | Trauma, Tricks of the Trade

By: Brian Lin, MD

Simulation Trick of the Trade: Bleeding Cricothyroidotomy Model

One advantage of simulation as an educational tool is the re-creation of cognitive and emotional stresses in caring for patients. Doing this for a high fidelity scenario is relatively easy – add additional patients, make a them loud, combative, or otherwise cantankerous, and add interruptions for good measure. However, when training for procedures in the simulation lab, we practice the procedure in isolation on a “task trainer” without cognitive and emotional stress for context. An off-the-shelf task trainer can do a superb job of teaching the mechanics of performing a procedure, but they lack complexity necessary to train for performing the procedure under stress. (more…)

2016-11-11T19:21:07-07:00

June 3rd, 2014 | Medical Education, Simulation, Tricks of the Trade

By: Jeffrey Hill, MD |Editors: Nikita Joshi MD

Trick of the Trade: Nail Bed Repair With Tissue Adhesive Glue

Patients with fingertip injuries involving the nail bed typically present to the emergency department and require meticulous repair of the nail bed to prevent long-term cosmetic and functional disability. There are several methods to repair nail beds, typically involving absorbable suture, but maybe there is a faster way with similar cosmetic and functional outcomes.

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2019-02-05T07:21:10-07:00

May 26th, 2014 | Trauma, Tricks of the Trade

By: Salim Rezaie, MD

Trick of the Trade: Making your own homemade ultrasound gel

You are spending a month in rural Kenya, doing an ultrasound teaching course. Your enthusiastic participants have been ultrasounding every chance they get. Unfortunately, this has caused your ultrasound gel supplies to dwindle. It will be a month before a new shipment of gel arrives from Nairobi. This gel will cost about $5 per bottle, which is a considerable expense for the local hospital’s budget.

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2018-10-28T21:23:04-07:00

April 17th, 2014 | Expert Peer Reviewed (Clinical), Tricks of the Trade, Ultrasound

By: Christine Riguzzi, MD

Trick of the Trade: Nasal foreign body removal using foley catheter

A healthy 4 year-old boy is brought in by mom for a plastic bead up his nose. The mom states, “The last time the other doctors had to be called, and it took forever. Oh, and I have to pick up his brother from school in 30 minutes. Can you get it out, doc?” The patient is squirming even as you take a quick peek at his nose, but you catch a glimmer of the bead up his right nare.

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2016-11-15T22:07:21-07:00

March 29th, 2014 | ENT, Tricks of the Trade

By: Maria Beylin, MD