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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By |2016-11-15T22:07:21-08:00Mar 29, 2014|ENT, Tricks of the Trade|

Safe dosing of nebulized lidocaine

NebulizersmSerum lidocaine levels correlate well with observed clinical effects. As the concentration increases, lightheadedness, tremors, hallucinations, seizures, and cardiac arrest can occur. Levels > 5 mcg/mL are associated with serious toxicity. With so many concentrations (1%, 2%, 4%) and routes of administration available, the total dose of lidocaine is always a concern.

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Trick of the Trade: Less traumatic nasopharyngoscopy


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A fiberoptic nasopharyngoscope is a handy tool to check patients for suspected foreign bodies (e.g. fishbone stuck in throat) or laryngeal edema. Depending on the diameter of your fiberoptic cable, it may be fairly uncomfortable for the patient despite generous viscous lidocaine instillation through the nares and nebulized lidocaine. Alternatively or additionally, you can make your own lidocaine-oxymetazoline nasal atomizer which works well.  

What if the patient is STILL not tolerating the procedure well? 

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By |2016-11-11T19:02:31-08:00Jul 16, 2013|ENT, Tricks of the Trade|

Trick of the Trade: Stabilizing mandibular relocations

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Three weeks ago, I talked about more safely reducing mandibular dislocations. After successful completion of the procedure, how do you make sure that the patient doesn’t re-dislocate the mandible? You definitely should tell the patient to keep their jaw closed as much as possible for the next 24 hours and avoid opening the mouth widely (eg. yawning/laughing).

How do you immobilize the mandible? Especially for the chronic dislocators, presumably with more lax TMJ ligaments, you should think about immobilization. This can be done with a head bandage which goes under the chin. You can use kerlix rolls or an ACE wrap.

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By |2019-01-28T22:19:51-08:00May 15, 2012|ENT, Tricks of the Trade|

Trick of the Trade: Protecting your thumbs in mandible relocations

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Does anyone think that this is generally a bad idea when closed-reducing mandible dislocations? Yes, it’s easiest to apply downward pressure on the mandible by pushing down on the occlusal surfaces of the molar teeth. Sometimes, however, when the mandible relocates into place, the teeth clamp shut abruptly – placing your thumbs at risk. How can you prevent any injuries to yourself?

One way is to slide gauze into the mouth during your procedure. Start the video around the 1:30 mark for an exam.

 

Trick of the Trade: Mandible Relocations

Apply a protective roll of gauze over each thumb. Additionally, you can wear a second glove to cover the gauze. No, those are NOT just fat thumbs under the gloves.

ThumbWraps1

ThumbWraps2 Thanks to Dr. Liz Brown (UCSF-SFGH EM resident) for the trick!

 
By |2016-11-11T18:45:03-08:00Apr 24, 2012|ENT, Tricks of the Trade|