Trick of the Trade: "Punch out" the foreign body

DoctorA patient re-presents to the Emergency Department with a foreign body sensation in his heel after stepping on a broken window. Despite a negative xray and bedside ultrasound yesterday, the patient still believes that a small foreign body is still in there.  You are unable to find a foreign body despite excising the overlying skin with a scalpel and exploring with forceps.

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By |2016-11-11T18:44:37-08:00Jun 12, 2012|Tricks of the Trade|

Trick of the Trade: Hair tourniquet release

449px-Hairtournequet

A 3 month old baby presents with distal erythema and swelling of one of her toes. A hair tourniquet is identified. Typically one can try manually unwrapping the tourniquet using forceps, but often only part of the tourniquet can be removed. The distal toe remains swollen and erythematous with delayed capillary refill.

As demonstrated by the image above, it can be difficult to identify the hair because of the edema and the thin nature of the hair (especially if the same as the patient’s skin color). In a 2006 review of hair tourniquets in the Annals of Plastic Surgery, they recommend incising down to the bone along the lateral edge of the digit to ensure tourniquet release. It seems a bit aggressive…
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By |2016-11-11T18:44:38-08:00Jun 5, 2012|Tricks of the Trade|

Trick of the Trade: Stabilizing mandibular relocations

MandibleBandage-1

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: 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|