Trick of the Trade: Converting % to mg/mL

Medication error is something that we all fear in Emergency Medicine and do our best to avoid. Here’s a scenario and simple approach for you, provided by Zlatan Coralic, PharmD (Assistant Clinical Professor in the UCSF School of Pharmacy).

You are an emergency physician working in an underserved country. You are presented with an asthmatic kid with severe retractions and tight wheezes. Multiple nebulizers and corticosteroids have failed. You want to try some magnesium sulfate before risking intubation in a place with no reliable access to ventilator equipment. You know the dose should be 1 gm IV over 20 minutes.

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By Zlatan Coralic, PharmD|2016-11-11T18:44:27-08:00Jul 17, 2012|Tox & Medications, Tricks of the Trade|

Trick of the Trade: Removing a Tungsten Ring Stuck on Your Finger

A patient presents with a tungsten ring on their injured finger and is unable to remove the ring. Tungsten rings are unique in that ring cutters can’t even make a scratch in them. There are even anecdotes of firefighter equipment not being able to cut off these “unbreakable” rings.

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By Michelle Lin, MD|2021-05-13T09:37:17-07:00Jul 10, 2012|Tricks of the Trade|

Trick of the Trade: Unblocking the obstructed IV line

A patient’s PICC line becomes obstructed and presents to your ED for care. She is using it for chronic antibiotics for osteomyelitis. You are unable to aspirate and flush it with saline using a 10 cc syringe.

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By Michelle Lin, MD|2022-03-26T14:43:51-07:00Jul 3, 2012|Tricks of the Trade|

Tricks of the Trade: Valsalva maneuver by using a 10 cc syringe

Last week, Dr. David Johnson shared his trick to elicit a Valsalva maneuver out of his patient. Here’s another trick that I saw one of our EM residents use in an attempt to break a SVT rhythm.

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By Michelle Lin, MD|2019-01-28T22:21:33-08:00Jun 26, 2012|Tricks of the Trade|

Trick of the Trade: Valsalva maneuver by pressing on the abdomen

A patient presents to triage in rapid SVT rhythm. While you are trying to get an IV in the patient and drawing up adenosine, you have the patient perform a Valsalva maneuver to see if increased vagal tone itself will break the arrhythmia. Unfortunately, she is unable to understand your instructions.

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By Michelle Lin, MD|2016-11-11T18:44:36-08:00Jun 19, 2012|Tricks of the Trade|

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

A 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 Michelle Lin, MD|2016-11-11T18:44:37-08:00Jun 12, 2012|Tricks of the Trade|

Trick of the Trade: Hair tourniquet release

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 Michelle Lin, MD|2021-05-15T10:02:11-07:00Jun 5, 2012|Tricks of the Trade|