• Lidocaine Bottle

Trick of the Trade: I need more lidocaine but I have sterile gloves on!

By |Categories: Tricks of the Trade|

How often has this happened to you — You are in the middle of a sterile procedure (chest tube, suturing, central venous line, lumbar puncture) and you realize that you need more lidocaine to provide better topical anesthesia. You don’t have any more in your kit and you are alone in the room with the patient. “Uh, can someone help me out there?” […]

  • Urine Cup Finger

Trick of the Trade: Fingertip injuries

By |Categories: Orthopedic, Trauma, Tricks of the Trade|

Fingertips can get injured in a variety of ways such as machetes, meat grinders, and broken glass. You name it, and we’ve probably seen it. Some don’t actually need anything invasive done because the skin is basically just torn off. The wound just needs to be irrigated, explored, and then bandaged to allow for secondary wound closure. What do you do if the finger injury keeps oozing and the finger tip is too painful for the patient to apply firm pressure? Poking the finger with 2 needles to perform a digital block seems a bit overkill. […]

Paucis Verbis: Pulmonary Embolism Clinical Prediction Rules

By |Categories: ALiEM Cards, Pulmonary|

“Should I get a D-Dimer test or CT chest angiogram on my patient with atypical chest pain to rule-out a pulmonary embolism?” This is a common question asked by emergency physicians on a routine basis. Here are 3 clinical prediction rules: PERC, Wells, and Simplified Geneva Score. Personally, I’ve never used the Geneva Score, but it’s worth looking at. […]

  • Tea bag

Tricks of the Trade: Tea bags to the rescue

By |Categories: Tricks of the Trade|

  I have heard of using tea bags under your eyes to reduce puffiness, but to combat odors in the ED? In my growing list of “Tricks of the Trade” tips for protecting your olfactory nerves (Antacid booties for toxic sock syndrome, aerosolized orange juice, abscess drainage using suction), I got a clinical gem from Dr. James Juarez (Rogue Valley Medical Center in Ashland, OR) after my recent Tricks of the Trade talk at High Risk EM in San Francisco. […]

  • Tourniquet

Trick of the Trade: Ring removal from a finger

By |Categories: Tricks of the Trade|Tags: |

   A patient presents with a swollen finger after falling and fracturing it. The patient is more distraught by the fact that she can’t get the ring off her finger. She implores you not to cut the ring off. There are textbook chapters written about tightly wrapping the digit with string from distal-to-proximal and sliding the string under the ring. Theoretically, the provider can pull and unwind the proximal end of the string to gradually coax the ring over the coils of string. I have personally found little luck with this maneuver.   […]