Nothing frustrates me more than not being able to obtain intravenous access in hemodynamically unstable patients, especially because I give a talk on “Troubleshooting the Difficult Vascular Access Patient.”
Recently on my ED shifts, there were several especially challenging endotracheal intubation scenarios.
In various ACEP News Tricks of the Trade columns, I have mentioned the importance of adequate lighting to visualize subtle injuries or pathologies. Traditional room overhead lighting is insufficient, especially if you are looking for that needle-in-a-haystack laceration in thick scalp hair or a tiny foreign body in a wound.
If you are using a traditional Tungsten penlight, you need to invest in a LED light source. LED penlights are very small (can fit on a keychain), super-bright, long-lasting, and costs only $3-30.
Tissue adhesives for wound closure often seem to intentionally make a bee-line straight for high-risk areas such as the eye. To avoid inadvertent application of the tissue adhesive, Dr. Hagop Afarian (UCSF-Fresno) utilizes a transparent tegaderm tape with an oval cut out of the center to provide a protective barrier. Immediately after application of the tissue adhesive, the tegaderm can be carefully peeled off to reveal a still-drying, well-circumscribed aliquot of glue over the wound. Be sure that the wound is dry, and the edges are well-apposed prior to tissue adhesive application.
This is a list of pearls and pitfalls that I share with the medical students and interns to whom I teach suturing and wound closure techniques. I can’t tell you how many pigs feet I have seen in my lifetime. Feel free to use and add to the list.
I just submitted my quarterly column installment on Tricks of the Trade in ACEP News on ENT dilemmas. Kids (and adults) get the most bizarre things in their ears and noses. I’ve seen a cockroach and Q-tips in the ear, and peas and pebbles in the nose. What have you seen, and what are your tricks for getting these things out?
