Trick of the Trade: Reverse sugar tong splint

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Distal radius fractures traditionally require a sugar tong splint to prevent the patient from ranging the wrist and elbow. The sugar tong splint essentially sandwiches the forearm with a splint, folded at the elbow. At this elbow fold, however, the splint often uncomfortably and inconveniently buckles and wrinkles when a wrap is applied. […]

Trick of the Trade: Toxic sock syndrome

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The olfactory nerve of an emergency physician is exposed to a broad range of smells in the Emergency Department. I’ve learned that the stinky-feet problem is a commonality amongst ED’s around the world! I call it the “toxic sock syndrome”. There are two remedies which I’ve been told of: Nebulized oil of wintergreen Placing a open canister of coffee grounds next to the feet (I’ve never understood this. I would imagine it would smell like stinky feet in a cafe. Plus, what a waste of coffee!) […]

Trick of the Trade: Needle thoracostomy

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On a shift last week, we had a patient present with a spontaneous pneumothorax. Not only that, but it was a tension pneumothorax. Although the patient was hemodynamically stable, he was very uncomfortable and really short of breath. To give us more time to prepare for the chest tube, it was decided to perform a needle thoracostomy. […]

Sneak Peak "Trick of the Trade": Digital nerve block

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The digital nerve block is common performed in the Emergency Department to provide anesthesia prior to wound closure. The digital nerves are typically accessed by injecting in the webspace on either side of the finger. Have you had patients start to get sweaty and anxious merely at the sight of your drawing up lidocaine in the syringe? Despite your reassurance that the 18-gauge needle that you used was just to move the lidocaine into the syringe and that you’ll be using a small needle for the procedure, they don’t look very reassured. Trust is key to having the procedure go [...]

Article review: CT irradiation exposure and risk

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I’m still working on my 2009 ACEP Scientific Assembly handout for the LLSA exam test prep session (which were actually due yesterday!). Even though the conference isn’t until mid-October, the handouts are always due a few months earlier. And every year, it sneaks up on me! One of the articles I’m reviewing is about the risks of CT irradiation, published in the New England Journal of Medicine in 2007. […]

Article review: Propofol (2007 ACEP Guideline)

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Given all the recent brouhaha around propofol and Michael Jackson, I thought I would review the 2007 Annals of EM Clinical Practice Advisory paper on the use of propofol in the Emergency Department for procedural sedation. This is one of the 2009 Lifelong Learning Self-Assessment (LLSA) articles. Each year EM-board certified physicians are tested on 20 pre-selected LLSA articles to maintain eligibility for re-certification. […]

Tricks of the Trade sneak peak: Teaching procedures

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Teaching procedural skills in medical school is increasing falling on the shoulders of emergency physicians. Two common problems that arise are the equipment expenses and simulation of realism. Working with my colleague Dr. Jeff Tabas, we came up some creative ideas around the teaching of (1) the Seldinger technique for central line placement and (2) saphenous vein cutdown. […]

Trick of the Trade: The Digi-Speculum

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Frequently patients present to the Emergency Department for lacerations, partial amputations, and abscesses of the fingers. After repairing the wound or injury, however, a bandage can be a bit unwieldy to apply and difficult to secure. To me, an ugly bandage just seems to detract from all of the diligent work that you just put into a plastic surgeon-quality wound repair. […]

Trick of the Trade for Intubation: Two hands are better than one

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Recently on my ED shifts, there were several especially challenging endotracheal intubation scenarios. A patient with thick frothy sputum constantly oozing out her trachea such that we couldn’t see the vocal cords– no matter how much suction we used. Imagine the Diet Coke and Mentos backyard experiment. I’m not kidding. A 300+ pound agitated trauma patient with almost no neck, who eventually was found to have an epidural and subdural hemorrhage. A COPD patient who was increasingly lethargic, hypoxic, and hypercarbic (pCO2>115), who I knew would start desaturating quickly as soon as rapid-sequence induction drugs were given. […]