Simulation Trick of the Trade: Paper Mache

MoneyTreeMoney doesn’t grow on trees, and neither do simulation manikins, not even on simulated trees. So what to do when you are looking for a cheaper, more easily replicated solution to simulation dilemmas? This is the perfect time to fall back on skills developed in childhood during Arts & Crafts hour. Consider paper mache!  So easy to use, and guaranteed to bring back childhood memories!

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2016-11-11T19:03:49-08:00

Simulation Trick of the Trade: Blindfold the Leader

67f84c2b0bdcd2f857a9a230de27924593f1d40aSimulations are routine now in medical training. But sometimes routine can start to get boring! All learners now know, especially for high fidelity simulations, to prepare for the unexpected. The stable patient will inevitably crash, maybe when your back is turned; the confederate in the room may or may not be a friend or a foe, you may never know! But these twists have become so integral to the simulation case that most learners know how to deal with it, or at the least know to anticipate it. But here is an idea for adding a new challenge to a stale simulation case. Blindfold the leader!

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2016-11-11T19:03:25-08:00

Trick of the Trade: The PIPP for deep peripheral IVs in obese patients

SVT_Lead_II-2The Case

A 500-pound morbidly obese male presents to your ED complaining of mild shortness of breath and palpitations. A quick ECG shows SVT with a rate of 160 bpm. His BP is in the 130s systolic, and he is otherwise stable. You know you have a bit of time. Meanwhile, the nurses begin searching for veins to start an IV…

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2016-11-11T19:02:44-08:00

Trick of the Trade: Less traumatic nasopharyngoscopy


ViscousLidoNosesm
A fiberoptic nasopharyngoscope is a handy tool to check patients for suspected foreign bodies (e.g. fishbone stuck in throat) or laryngeal edema. Depending on the diameter of your fiberoptic cable, it may be fairly uncomfortable for the patient despite generous viscous lidocaine instillation through the nares and nebulized lidocaine. Alternatively or additionally, you can make your own lidocaine-oxymetazoline nasal atomizer which works well.

What if the patient is STILL not tolerating the procedure well?

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2016-11-11T19:02:31-08:00

The Dirty Epi Drip: IV Epinephrine When You Need It

PeanutAllergyBraceletYou’re a recent graduate picking up an extra shift in a small ED somewhere north of here. At 3 AM an obese 47 year-old woman presents with shortness of breath and difficulty speaking after eating a Snickers bar an hour earlier. She admits to history of hypertension, peanut allergy, and a prior intubation for a similar presentation. She is becoming more obtunded in the resuscitation room as you are collecting your history. A glance at the monitor shows:

  • HR 130
  • BP 68/40
  • O2 saturation 89% on room air

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Trick of the Trade: Got a shoulder dislocation? Park it

ShoulderDLxray

Myriad techniques exist to reduce shoulder dislocations, which includes scapular rotation, Hennepin, Snowbird, Cunningham, and Legg maneuvers. They are nicely reviewed at ShoulderDoc.co.uk. You can also supplement any technique with ultrasound-guided intraarticular lidocaine for improved pain control.

Recently, Dr. Jay Park (Beth Israel Medical Center in New York) contacted me about his novel approach to shoulder reduction which anatomically makes sense. If his animation video doesn’t convince you, check out the video of an actual reduction.

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2019-01-28T21:59:02-08:00