I rarely access the femoral vein for central venous catheterization… except in medical or trauma resuscitations. Oftentimes in these resuscitations, there are too many people near the IJ or subclavian vein site. People are intubating, performing CPR, trying to get peripheral vein access, etc.
Does your endotracheal tube get caught up on a swollen or floppy epiglottis during insertion?
Occasionally the endotracheal tube may become “caught up” along the epiglottis. Because it is difficult to predict when this may happen, pre-lubricate the endotracheal tube cuff and tip with a thin layer of water-soluble lubricant, such as K-Y jelly. This lubricant can also minimize the degree of surface trauma to the trachea and tracheal rings as the tube passes the vocal cords.
Many patients present to the Emergency Department for low back pain. Determining whether these patients have a red-flag diagnosis can be difficult. Red flag diagnoses include:
Almost all patients presenting with back pain, whether it be a muscle spasm or a spinal epidural abscess, will have back tenderness to some extent. So, how can you better differentiate benign from dangerous etiologies?
How do you splint 2nd or 3rd metacarpal fractures? A short arm volar splint is usually applied, because a fracture should be immobilized one joint distal and proximal to the injury. This splint, however, unnecessarily immobilizes the 4th and 5th fingers. It makes gripping things with your hand difficult.
How long is this neck laceration?
In the Emergency Department, it is important to be able to accurately estimate the length of wounds, abscesses, and cellulitis. Additionally, billing for wound closure is directly related to the length of the laceration.
Eyelids can become edematous from blunt trauma and local inflammation, making it difficult to visualize the orbit. How do you retract the eyelids, if you don’t have the fancy ophthalmology eyelid retractors?
Use a Q-tip
I thought of this idea when I was rolling up a projector screen in a conference room. Why can’t we use this rotational concept on the upper eyelid to retract it? Rest the Q-tip on the surface of the upper eyelid and slowly rotate the Q-tip to “roll” the eyelid out of the way.
Below are a series of photos of a woman with eyelid swelling from conjunctivitis. This technique provides a relatively painless way to retract the eyelid without placing pressure on the orbit itself. Although the images look like I am merely lifting the eyelid using the Q-tip, I am actually twirling the Q-tip.
Morgan lens are placed to irrigate eyes splashed with foreign substances. Whenever I place them, images of horror and torture movies arise. Especially for patients who aren’t used to having something touch their eyes like contact lens, the Morgan lens gives them the heeby-jeebies.
For the past several years, I’ve stopped using Morgan lens and have started using something that all Emergency Departments have — nasal cannulas for oxygen administration. They are perfect for high-volume eye irrigation.
