Trick of the Trade: Seldinger chest tube technique using bougie

HemoPTXA 40 year-old man presents with a traumatic hemopneumothorax. He weighs 400 pounds.

Chest tubes can sometimes be challenge, especially for those with extra redundant tissue to tunnel through before reaching the intrathoracic cavity. You want to avoid placing the chest tube mistakenly in the subcutaneous space. How can you ensure that your chest tube actually reaches the intrathoracic space?

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By |2019-01-28T22:18:57-08:00May 1, 2012|Social Media & Tech, 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|

Trick of the Trade: Peritonsillar abscess aspiration technique

Photo1_MacbladesmA few weeks ago, I gave a Tricks of the Trade talk for the Stanford-Kaiser Emergency Medicine residents and faculty. I was overwhelmed by the great, creative ideas that came up during our discussion.

An always popular topic is the drainage of peritonsillar abscesses. Sometimes it can be difficult to aspirate from a syringe using only one hand, especially with the awkward angle that you might encounter.   I can never find syringes with the side rings to allow you to grasp the syringe more securely with one hand (see photo above).

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By |2019-07-30T15:31:24-07:00Apr 17, 2012|ENT, Tricks of the Trade|

Trick of the Trade: Urine pregnancy test without urine

pregnancy_tests_in_bulkA 25 year old woman presents to the Emergency Department having syncopized in the waiting room, where she was triaged with the chief complaint of abdominal pain. Ectopic pregnancy immediately bubbles to the top of your differential diagnosis. The patient is too dizzy to walk to the bathroom to give you a urine specimen to check a urine pregnancy test. Plus, she admits that she just urinated in the waiting room bathroom a few minutes ago – so no urine now.

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Trick of the Trade: Fluorescein eyedrops

FluoresceinStrip
This is a guest post by Dr. Ian Brown (Stanford):

The Roberts textbook describes the procedure of corneal fluorescein staining as touching a moistened fluorescein strip to the cornea.  Maybe it is an irrational fear of a paper cut to the sclera, or a fear of touching an already abraded cornea with the paper, but I try to find an alternative. I have seen physicians hold the eye open with one hand, hold the fluorescein with a second hand and then drip tetracaine on the paper and let it drip into the eye with a third hand. I, unfortunately, only have two hands.
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By |2019-01-28T23:36:28-08:00Mar 27, 2012|Ophthalmology, Tricks of the Trade|

Trick of the Trade: Pelvic speculum for peritonsillar abscess

PTA 1 LabeledPeritonsillar abscess drainage in the ED continues to be one of my favorite procedures to perform. There are several tricks to increase your chances for a successful aspiration. One trick involves using a curved laryngoscope to help depress the tongue AND provide a bright light source.

What if you don’t have a laryngoscope readily available?

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By |2019-01-28T23:36:17-08:00Mar 20, 2012|ENT, Tricks of the Trade|

Trick of the Trade: Irrigation fluid is key – but not in your eye!


SplashIrrigation
High pressure irrigation of wounds is critical in reducing the rate of wound infection. There are a variety of commercial irrigation kits which include splash guards. If you are irrigating correctly and generating at least 8 PSI of pressure, some irrigation fluid should splash up and out of the wound. Be careful not to splash irrigation fluid in your eyes.

What if you don’t have a commercial irrigation setup?

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By |2019-02-19T18:07:59-08:00Mar 13, 2012|Tricks of the Trade|