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.
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.
You walk into a room where a patient is screaming and thrashing about in his/her gurney from some stimulant abuse. PCP, cocaine, methamphetamine… or all of the above.
When the number of people (police officers, security guards, nurses) is greater than the patient’s pupil size, you KNOW that you’ll need some chemical sedation.
Building on my theme of combating odors in the Emergency Department (see Toxic Sock Syndrome), foul-smelling pus from large abscesses has got to be one of the most nauseating smells in the ED for me.
Use a Yankauer to suction up pus
I mentioned from an earlier post about building a “head basin” for collecting irrigation fluid prior to wound closure. This basin prevents a deluge of fluid from soaking the gurney sheets and patient.
I finally managed to capture this trick in action, while a student was irrigating an eyebrow laceration.
When cutting out a semi-circular or rectangular hole in the basin, be sure that there remains a 2-4 inch lip at the bottom to ensure that fluid can collect in the basin.
Before I start creating a new talk, I ask myself 3 questions:
Occasionally, I get a rare – “Hey congrats on the article!” comment from residents or students. It’s usually in reference to my ACEP News column that comes out every 3 months on Tricks of the Trade. However, I got about 3 shout-outs in the past 2 days. How odd.
Then I saw one of our office staff who was reading EM News. “Hey cool!” she said. Totally confused, I realized that I was quoted on the front page of this week’s publication about iPhone applications in EM. Many months ago, I had done a brief telephone interview with the writer.