Trick of the trade: Percuss the spine in low back pain

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:

Fracture
Cauda equina syndrome/ spinal cord compression
Spinal infection
Vertebral malignancy

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?

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By Michelle Lin, MD|2016-11-11T19:01:21-08:00May 5, 2010|Tricks of the Trade|

Trick of the Trade: Radial Gutter Splint

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.

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By Michelle Lin, MD|2016-11-07T08:31:32-08:00Apr 28, 2010|Orthopedic, Tricks of the Trade|

Trick of the Trade: A "handy" ruler

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.

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By Michelle Lin, MD|2016-11-11T19:01:22-08:00Apr 21, 2010|Tricks of the Trade|

Trick of the Trade: Retracting Swollen Eyelids

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?

Trick of the Trade

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.

Consent and photographs taken by Lourdes Adame
(Visual Aid Project member)

By Michelle Lin, MD|2019-01-28T23:42:58-08:00Apr 14, 2010|Ophthalmology, Tricks of the Trade|

Trick of the trade: Eye irrigation setup

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.

Instead of attaching the nasal cannula to an oxygen port, attach it to the end of IV tubing, which in turn is attached to a 1 liter normal saline bag. The IV tubing fits snuggly into the nasal cannula tubing.

Rest the nasal cannula prongs over the patient’s nasal bridge to irrigate the eyes.
Then open up the flood gates!
To avoid a huge deluge of fluid onto the patient and floor, be sure to have a way to catch the fluid. Some place multitudes of towels around the patient’s head to absorb the fluid.
As an alternative solution to towels, I like Dr. Stella Yiu’s (Univ of Toronto) adaptation of my cut-out basin approach for irrigating scalp wounds. To avoid overflow spillage, she rests a Yankauer suction tip at the bottom of the basin to collect the irrigation fluid.

By Michelle Lin, MD|2019-02-19T18:53:53-08:00Apr 7, 2010|Ophthalmology, Tricks of the Trade|

Tricks of the trade: Anesthetizing the nasopharyngeal tract

Nasogastric tube placement is one of the most uncomfortable procedures in the Emergency Department. Why can’t we find a painless way to do this?

Now that I am doing more fiberoptic nasopharyngoscopes, this issue is coming up more and more frequently. I’ve been using NP scopes mainly to check for laryngeal edema in the setting of angioedema. These recent photos visualize a normal epiglottis and normal laryngeal anatomy, respectively.

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By Michelle Lin, MD|2016-11-11T19:01:27-08:00Mar 31, 2010|Tricks of the Trade|

Trick of the trade: Ear foreign body extraction

A 6-year old boy has placed a hard bead in his ear and presents to the ED for care. How do you remove this foreign body as painlessly as possible? You can just barely see the edge of the bead by just looking at the external ear.

By experience, you know that mini-Alligator clips and forceps will not be able to sufficiently grab the edges of the bead. Additionally it may push the bead in even further.

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By Michelle Lin, MD|2019-02-19T18:08:04-08:00Mar 24, 2010|ENT, Tricks of the Trade|

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