Trick of the Trade: Bandaging the scalp laceration

ScalpLac2

Scalp lacerations are one of the most common injuries which present to the Emergency Department. Applying a dry bandage over the staples or sutures can be a challenge because the tape just has nothing to adhere to.

We reviewed the use of tubular cotton gauze to create a beanie hat, but what should you do if you can’t find any tubular gauze? Ever since I wrote about the beanie hat trick, people in the ED have been using the tubular gauze more and we’re always out of stock whenever I look for it!

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By |2019-02-19T18:08:01-08:00Dec 5, 2011|Tricks of the Trade|

Trick of the Trade: Securing a peripheral IV on sweaty skin


IVcathetherTape
Patients can become extremely diaphoretic with high fevers or if under the influence of PCP or a stimulant. Slippery, sweaty skin can pose a problem when securing peripheral IV’s. Adhesive tapes that are typically designed for securing these IV’s often slip off… immediately followed by the IV falling out.

How can you secure the IV … without using staples and sutures?

By |2016-11-11T18:51:44-08:00Nov 29, 2011|Tricks of the Trade|

Trick of the Trade: Ultrasound-guided injection for shoulder dislocation

ShoulderDislocation

Who loves relocating shoulder dislocations as much as I do? I know you do.

Often patients undergo procedural sedation in order to achieve adequate pain control and muscle relaxation. Alternatively or adjunctively, you can inject the shoulder joint with an anesthetic. Personally, I have had variable effectiveness with this technique. In cases of inadequate pain control, I always wonder if I was actually in the joint.

How can you improve your success rate in injecting into glenohumeral joint injection?

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By |2019-01-28T22:35:26-08:00Nov 8, 2011|Orthopedic, Tricks of the Trade, Ultrasound|

Trick of the trade: Nebulized naloxone

NaloxoneOverdoses of long-acting opiates, such as oxycodone and methadone, are challenging to manage, especially if these patients are chronically on opiates.

On the one hand, you want to reverse some of the sedative effectives with naloxone so that they aren’t near-apneic and hypoxic. You also want to be able to take a history from them. On the other hand, you don’t want to abruptly withdraw them with naloxone such that they become violent and agitated. It is a fine balancing act.

Long-acting opiates present a separate challenging because naloxone wears off fairly quickly in 30-45 minutes. These patients may require repeat dosings and/or a naloxone IV drip.

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By |2019-01-28T22:35:16-08:00Nov 1, 2011|Tox & Medications, Tricks of the Trade|

Trick of the Trade: Nasal cannula oxygenation during endotracheal intubation

CloseUpHeadElevatedTrumpet

You are managing a 300-pound patient with a long history of severe COPD, who now requires intubation because of a pneumonia and COPD exacerbation. You anticipate that the patient may be a difficult airway intubation and may desaturate quickly during laryngoscopy. While you are setting up to orotracheally intubate this patient, you preoxygenate this patient as best as you can with a non-rebreather mask.

What can you do to prolong the patient’s time-to-desaturation so that you aren’t as rushed to place the endotracheal tube?

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By |2019-01-28T22:35:50-08:00Oct 25, 2011|Tricks of the Trade|