Tricks of the Trade: Fluorescein application techniques for the eye

Application of fluorescein is a vital part of the workup of ocular complaints. Despite some studies showing questionable support, the typical cited clinical concern for stored fluorescein solutions is contimination with Pseudomonas and risk for iatrogenic infection with associated ulcer formation. ^1–4 Subsequently, single dose sterile strips have become the standard agent stocked in most EDs. Many patients, especially children, can be apprehensive of the application of the physical strip directly to the eye, and are more comfortable with the concept of eye drops. In this post, we review multiple technique to create fluorescein solutions and additional tips for utilization that may be integrated into your practice, depending on the supplies available to you.
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By Sam Shaikh, DO|2019-02-19T18:59:57-08:00Jun 11, 2015|Ophthalmology, Tricks of the Trade|

Trick of the Trade: Eye pH

Your patient presents with an ocular burn after accidentally splashing an industrial acid on his face. You, however, can not seem to find the ever elusive eye pH paper to track her initial and serial pH’s during copious ocular irrigation. Now what?

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By Michelle Lin, MD|2016-10-26T17:04:28-07:00Jun 10, 2015|Ophthalmology, Tricks of the Trade|

Trick of the Trade: Needle-vein alignment in ultrasound guided peripheral IV

Placing a peripheral IV under ultrasound guidance is often much more challenging than it outwardly appears, especially for novice users. One of the more difficult aspects is in making sure that the target vessel is perfectly in the middle of the screen and then guessing where that corresponds to the middle of the ultrasound probe.

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By Jeff Wiswell, MD|2016-10-26T17:04:32-07:00Feb 23, 2015|Tricks of the Trade, Ultrasound|

Trick of the Trade: L5 medial hamstring reflex

Traditionally in medical school, it is taught that lower extremity deep tendon reflexes for L4 and S1 nerve root levels can be elicited by tapping on the patella and Achilles tendons. It was just taught that L5 didn’t have a reflex to check. Knowing if an L5 radiculopathy existed would be especially helpful when assessing a patient for a potential lumbar disc herniation where a careful lower extremity neurologic exam is important. It turns out one can actually check for a L5 reflex.

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By Michelle Lin, MD|2019-01-28T21:44:46-08:00Feb 9, 2015|Neurology, Tricks of the Trade|

Trick of the Trade: Knee Arthrocentesis

A patient comes into the ED and you suspect septic arthritis to the knee. As you consent the patient for arthrocentesis, you can tell s/he has reservations about a needle being inserted into their knee and left in place while you aspirate. You also think in the back of your mind how tricky it is to sometimes change syringes while keeping the needle in the correct location. Is there another way of tapping the knee without a needle?

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By Fred Wu, MHS, PA-C|2019-02-19T18:42:04-08:00Jan 8, 2015|Expert Peer Reviewed (Clinical), Orthopedic, Pre Publication Critique (Clinical), Tricks of the Trade|

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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By Yen Chow, MD CCFP|2016-11-11T19:35:39-08:00Nov 26, 2014|ENT, Tricks of the Trade|

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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By Mitchell Li, MD|2017-05-06T20:32:25-07:00Oct 2, 2014|ENT, Tricks of the Trade|

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