Trick of the Trade: Difficult intubation — making lemonade out of lemons

IPoolBloodn many cases of massive GI bleeding, airway control is essential. During endotracheal intubation, suction sometimes just isn’t adequate enough to allow to get a good view of the vocal cords. The pool of blood keeps re-accumulating faster than you can suction. You think you see an arytenoid, pointing you in the direction of the trachea, and so you slide the endotracheal tube in.

Unfortunately, when you bag the patient, you realize that you are in the esophagus.


By |2016-11-11T18:51:16-08:00Jan 31, 2012|Tricks of the Trade|

Trick of the Trade: Minimizing propofol injection pain

Propofol“Ow, that burnnnnssss… ow! ow! ow! … zzzzzz…

As many as 60% of patients report significant pain with the injection of IV propofol. Once a patient experiences pain, it’s too late to reverse it. Often all you can do is to tell them that the pain will subside in a few seconds. What can you do preemptively to minimize the pain of propofol injection?


By |2019-01-28T22:23:58-08:00Jan 24, 2012|Tox & Medications, Tricks of the Trade|

Trick of the Trade: Dental Avulsion and Subluxation

It’s a Friday evening shift in the “minor area” of your ED and a young woman who had imbibed a little too much alcohol comes in with an avulsion of her first left upper incisor after falling and striking her face against the ground.  She’s crying because of the event but is otherwise unscathed.  At this point it’s time to take care of the avulsion.  What to do? (see PV Card on ED Treatment of Dental Trauma)


By |2016-11-11T18:51:18-08:00Jan 17, 2012|Dental, Tricks of the Trade|

Trick of the Trade: A removable guidewire

An essential skill of any innovative troubleshooter in the Emergency Department is the ability to recognize when one piece of equipment may be used elsewhere. For instance, what’s your go-to approach when looking for a spare guidewire? Let’s say you are trying to salvage an ultrasound-guided basilic vein IV catheterization.

Here’s where I go for guidewires:

  • Central line kits
  • Pneumothorax pigtail kits
  • Seldinger-based cricothyrotomy kits


By |2016-11-11T18:51:26-08:00Jan 10, 2012|Tricks of the Trade|