Trick of the Trade: Identifying Team Members in Protected Code Blues

Your team in the Emergency Department (ED) receives a call from your local Emergency Medical Services (EMS) crew informing you that they are transporting a patient with high suspicion of COVID-19 in severe respiratory distress. As you assemble your team in preparation for a Protected Code Blue (PCB), your staff (including physicians, nurses, respiratory therapists, etc.) begins donning full Personal Protective Equipment (PPE). PPE includes donning a gown, gloves, face mask, goggles and/or a face shield.

With several team members assembled in the resuscitation bay in full PPE, it can be challenging to identify specific individual members of the team and their role.

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By Jeffrey Shih, MD, RDMS|2020-04-05T13:04:58-07:00Apr 6, 2020|COVID19, Tricks of the Trade|

Trick of the Trade: Face mask hacks

A 35-year-old male working as a healthcare worker presents for evaluation of ear discomfort. The skin behind his ears has been red and irritated since having to wear a surgical face mask with the majority of his patient interactions [1]. He has tried to minimize wearing his mask in the appropriate circumstances, using lotions and emollients, but still has a significant amount of discomfort [2].

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By Luz Maria Silverio, MD|2026-08-26T10:46:21-07:00Apr 1, 2020|COVID19, Tricks of the Trade|

Trick of the Trade: Deflate an Undeflatable Gastrostomy Tube

A 54-year-old female with a past medical history of throat cancer presents for gastrostomy tube (G-tube) replacement. The initial G-tube was placed 3 years ago. Most recently, the patient had the G-tube changed 7 months ago. She presents to the Emergency Department because the G-tube is leaking from the tubing that is external to the skin. When you attempt to deflate the cuff, you are unsuccessful.

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By Brendan Leach, DO|2020-02-13T22:46:36-08:00Feb 19, 2020|Gastrointestinal, Tricks of the Trade|

Trick of the Trade: Tracheostomy leak temporization

Patients who are tracheostomy and ventilator dependent are at increased risk for complications the longer they remain in this condition. One common complication is tracheomalacia. Progressive tracheomalacia can lead to air leaks around the tracheostomy cannula balloon. Initially, this can be managed by placing a longer tracheostomy cannula deeper into the trachea, however, these are often unavailable in the emergency department [1]. A second line strategy is to temporarily over-inflate the balloon, however, with chronic overinflation, eventually both the trachea and the neck stoma become too large, leading to an inability to maintain appropriate positive pressure (PEEP) and tidal volume necessary to ventilate the patient [2].

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By Steven Obrzut, DO|2020-05-21T18:27:01-07:00Feb 3, 2020|ENT, Tricks of the Trade|

Trick of the Trade: Directed Saline Irrigation for Nasal Suctioning

You are just starting out your mid-January evening shift, and you go to the room of an 8-month old male with nasal congestion. He is afebrile, and mildly tachycardic, but his lung exam is fairly benign and he’s breathing easily without retractions. You can clearly see he has congestion. You instruct the parents to use saline irrigation and then nasal suctioning to clear the congestion as needed, and they say, “How can we do this if our child struggles? Won’t we just end up with a wet, angry, and congested child?”

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By Kavita Joshi, MD|2020-01-16T16:11:53-08:00Jan 15, 2020|Emergency Medicine, Pediatrics, Tricks of the Trade|

Trick of Trade: Topical lidocaine jelly takes the tears out of skin tears and road rash

Skin tears are a common injury treated in the elderly in the emergency department (ED). Often the skin is paper thin, and the area involved can have a large flap. By the time the patient has arrived, the may blood have dried with a retracted and rolled-in skin flap. Often the surface area is too big and skin to thin to inject local anesthesia around the entire site.

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By Kara Bragg DNP, APRN, FNP-C, ENP-BC|2019-11-30T18:19:15-08:00Dec 11, 2019|Trauma, Tricks of the Trade|

Trick of the Trade: Combine Adenosine with the Flush

2019 literature update from this original 2012 Trick of the Trade post!

The success of adenosine depends as much on the administration technique as it does the mechanism of action. The 2010 Advanced Cardiac Life Support (ACLS) Guidelines recommend the following when administering adenosine:

“6 mg IV as a rapid IV push followed by a 20 mL saline flush; repeat if required as 12 mg IV push”

This recommendation remained in the 2015 iteration.

While most drugs are metabolized in the liver, adenosine doesn’t even make it that far, being metabolized in the erythrocytes and vascular endothelial cells. With this extremely short half-life (10 seconds), it is important to help it reach the heart before it’s metabolized and excreted without being effective.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2024-06-18T22:34:55-07:00Oct 31, 2019|Cardiovascular, Tox & Medications, Tricks of the Trade|