Trick of the Trade: "Pour some sugar on me"


RectalProlapseDiagram
Rectal prolapses are typically caused by weakened rectal muscles, continued straining, stresses during childbirth, weakened ligaments, or neurological deficits.

How do you fix them? You can attempt manual reduction of the prolapse by using direct pressure. On the other extreme, corrective surgery can be performed from either an abdominal or perineal approach.

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By |2016-11-11T19:00:31-08:00Sep 1, 2010|Gastrointestinal, Tricks of the Trade|

Trick of the Trade: Increasing students responses to the differential diagnosis

DiagnosisAnyone who teaches medicine asks students to list their differential diagnosis when discussing a new clinical case. It’s also part of several models for education including the One-Minute Preceptor and SNAPPS.

For the most part, students are good at coming up with answers to the differential, but what do you do when they strike out? Or what if the answer is always the same, i.e. chest pain = myocardial infarction?

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Trick of the Trade: Modified HAT trick revisited

I finally tried the Modified HAT (Hair Apposition Technique) trick for the closure of scalp lacerations. I have used the traditional HAT trick multiple times but not the modified technique.

What’s the difference?

Instead of using your fingers, the modified approach involves the use of two instrument clamps to help twist and pull the hair strands taut. It turns out that this makes a huge difference, especially for short hairs. The clamps allow you to grab the hair strands so much more securely, before instilling a tissue adhesive at the twisting points.

The nice added benefit was that my chubby fingers were now out of the procedural field. This allowed my assistant to more easily see and reach the hair twisting points with the Dermabond applicator.

Check out the finished product of this 2.5 cm laceration on the scalp vertex.

Back Camera

Bottom line

The simple addition of two instrument clamps provides significantly superior control, stronger tensile strength, and better exposure when twisting hair strands together. Try it.

By |2019-11-20T18:11:20-08:00Aug 18, 2010|Tricks of the Trade|

Trick of the Trade: Prescribing opiates

 

PrescriptionPadAs emergency physicians, we are experts in pain control. We frequently write opiate prescriptions for patients being discharged home. Unfortunately, an occasional patient tries to forge my prescription. At times, I get a call from pharmacy for prescriptions that were suspiciously written. For instance several years ago, I had someone try to forge 100 tablets of “Mophine”.

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By |2016-11-11T19:00:35-08:00Aug 4, 2010|Tox & Medications, Tricks of the Trade|

Trick of the Trade: A tongue blade is as mighty as an xray

Patients often present to the Emergency Department for mandibular blunt trauma. Usually these patients have soft tissue swelling at the point of impact. In mandibular body fractures, the fracture line often extends to the alevolar ridge. This may cause a gap between a pair of lower teeth.

In patients with jaw pain, mild swelling, and normal dentition, is there a way to avoid imaging these patients to rule-out a mandible fracture?

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By |2016-11-11T19:00:37-08:00Jul 21, 2010|ENT, Tricks of the Trade|

Trick of the Trade: OKN drum to test psychogenic coma

3D Character and Question MarkOccasionally, emergency physicians see patients who present because they are unresponsive despite normal vital signs and an otherwise normal exam. You detect no drugs or alcohol on board. You suspect a psychiatric or malingering etiology, but aren’t sure. They seem non-responsive to voice and minimally responsive to very painful stimuli. Is this a case of psychogenic coma or true coma (with bilateral hemispheric dysfunction)?

What test can you do to reassure yourself that this may indeed be psychogenic coma?

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By |2019-01-28T23:37:29-08:00Jul 14, 2010|Neurology, Tricks of the Trade|
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