Trick of the Trade: Don’t miss the pneumothorax in needle thoracostomy

PTXtensionA patient arrives in PEA arrest and you note that her left chest has no breath sounds or lung sliding on bedside ultrasound. You suspect a tension pneumothorax.

You insert a standard 14g angiocather in the left 2nd intercostal space (ICS). You don’t hear a rush of air. The patient’s clinical condition deteriorates to impending asystole. How sure are you that your angiocatheter actually reached the pleural space?


By |2017-08-03T00:59:44-07:00Oct 2, 2012|Tricks of the Trade|

Tricks of the Trade: Calcium gel for hydrofluoric acid burns

HydrofluoricAcidA 41 y/o m presents to your ED after an occupational exposure to 30% hydrofluoric acid (HF). The thumb and index finger of his right hand were affected. Upon visual examination, the site of exposure looks relatively benign but the patient is complaining of extreme pain. Beyond giving opioids, what can you do?


Trick of the Trade: Pass the mayo – getting off black tar


Industrial accidents sometimes involve hot coal tar stuck to a patient’s skin. Coal tar is notoriously challenging to remove once it has cooled and adhered to the skin. The tradition teaching is to apply large quantities of petroleum jelly to the black tar, let it sit for at least 60 minutes, and then diligently try to rub away the tar. Repeat as needed. What if you don’t have any petroleum jelly or petroleum-based products?


By |2019-01-28T22:13:20-08:00Sep 4, 2012|Tricks of the Trade|
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