Trick of the trade: Endotracheal tube lubrication

Does your endotracheal tube get caught up on a swollen or floppy epiglottis during insertion?

Trick of the Trade: Endotracheal tube lubrication

Occasionally the endotracheal tube may become “caught up” along the epiglottis. Because it is difficult to predict when this may happen, pre-lubricate the endotracheal tube cuff and tip with a thin layer of water-soluble lubricant, such as K-Y jelly. This lubricant can also minimize the degree of surface trauma to the trachea and tracheal rings as the tube passes the vocal cords.

By Michelle Lin, MD|2016-11-11T19:00:45-08:00May 26, 2010|Tricks of the Trade|

Paucis Verbis card: Ottawa knee, ankle, and foot rules

Often times, I get called to triage to help decide whether a patient should be sent to Radiology for an initial x-ray after injuring their knee, ankle, and/or foot. After teaching one of the nurses about the Ottawa rules, she taped a list of these rules on the triage wall.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews Ottawa Knee, Ankle, and Foot Rules.

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By Michelle Lin, MD|2021-10-19T19:39:35-07:00May 7, 2010|ALiEM Cards, Orthopedic, Radiology|

Trick of the trade: Percuss the spine in low back pain

Many patients present to the Emergency Department for low back pain. Determining whether these patients have a red-flag diagnosis can be difficult. Red flag diagnoses include:

Fracture
Cauda equina syndrome/ spinal cord compression
Spinal infection
Vertebral malignancy

Almost all patients presenting with back pain, whether it be a muscle spasm or a spinal epidural abscess, will have back tenderness to some extent. So, how can you better differentiate benign from dangerous etiologies?

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By Michelle Lin, MD|2016-11-11T19:01:21-08:00May 5, 2010|Tricks of the Trade|

Paucis Verbis card: Vasopressors and Inotropes for Shock

The treatment of shock should focus on correcting the underlying pathophysiology. With persistent hemodynamic instability, a vasopressor and/or inotrope should be selected. Reviewing receptor physiology can help you select the best-fit agent for the patient’s clinical condition. There is an especially useful table on medication selection in the reviewed 2008 EM Clinics of North America article.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews Vasopressors and Inotropes for the Treatment of Shock.

PV Card: Vasopressors and Inotropes in Shock

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Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Edit 3/28/14: Dopamine removed as second-tier agent for septic shock (mainly reserved for rare cases of inappropriate bradycardia at low risk for arrhythmias)

Reference

Ellender T, Skinner J. The use of vasopressors and inotropes in the emergency medical treatment of shock. Emerg Med Clin North Am. 2008;26(3):759-86, ix. [PubMed]

By Michelle Lin, MD|2021-10-19T18:48:16-07:00Apr 30, 2010|ALiEM Cards, Cardiovascular, Tox & Medications|

Trick of the Trade: Radial Gutter Splint

How do you splint 2nd or 3rd metacarpal fractures? A short arm volar splint is usually applied, because a fracture should be immobilized one joint distal and proximal to the injury. This splint, however, unnecessarily immobilizes the 4th and 5th fingers. It makes gripping things with your hand difficult.

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By Michelle Lin, MD|2016-11-07T08:31:32-08:00Apr 28, 2010|Orthopedic, Tricks of the Trade|

Paucis Verbis card: Skipping the CT prior to LP for meningitis

With increasing awareness of CT’s irradiation risk, I thought I would review a classic 2001 article from the New England Journal of Medicine. Head CT’s previously were commonly performed prior to all lumbar punctures (LP) to rule-out meningitis. When can you safely go straight to an LP without imaging?

Caveat: This review only applies to those patients in whom you suspect meningitis. This does not apply to those being worked up for subarachnoid hemorrhage.

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By Michelle Lin, MD|2021-10-19T19:36:53-07:00Apr 23, 2010|ALiEM Cards, Neurology, Radiology|

Trick of the Trade: A "handy" ruler

How long is this neck laceration?

In the Emergency Department, it is important to be able to accurately estimate the length of wounds, abscesses, and cellulitis. Additionally, billing for wound closure is directly related to the length of the laceration.

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By Michelle Lin, MD|2016-11-11T19:01:22-08:00Apr 21, 2010|Tricks of the Trade|