Tricks of the Trade: Low tech solutions to esophageal foreign bodies
Patients can present to Emergency Departments with esophageal foreign bodies. Recently, a patient presented with a doxycycline pill stuck in her esophagus at the mid-chest level. She was taking it for pneumonia. Despite drinking deluges of water for the past 12 hours, the pill remains stuck. You know that doxycycline (pills shown on right) is one of several medications (along with iron or potassium supplements, quinidine, aspirin, bisphosphonates) known for causing erosive pill esophagitis. She presents to your ED. What do you do? With so many direct visualization tools in the ED now available to emergency physicians such as Glidescopes [...]
Trick of the trade: Straightening the guidewire
Did you know that a medical guidewire consists of a flexible central “ribbon wire” externally wrapped with a coil-spring wire? J-shaped guidewires are commonly used in many medical procedures, such as central lines, arterial lines, and pigtails for pneumothoraces. Knowing more about the guidewire makes it possible to carry out a unique Trick of the Trade. For example, let’s say that the plastic introducer is missing or unusable. Using one hand to stabilize the needle in the patient, how do you use your other hand to re-insert a curved guidewire tip into the hub of a needle? […]
Trick of the Trade: Style points in pediatric orthopedics
With this hot summer season in California, kids have been running around and getting into all sorts of orthopedic troubles. Monkey bars are a common culprit. In treating pediatric patients in the ED, it's worth spending an extra few minutes on the subtle style points. Trick of the Trade: Splint the buddy bear You should consider keeping a stash of stuffed teddy bears in the ED for those patients, whom you splint or cast. It is a nice touch to have the patient go home with a teddy bear with the same "injury" and splint/cast. It's the little touches that [...]
Trick of the Trade: The key to pollution is dilution
Wound care mantra: “The key to pollution is dilution.” High-pressure irrigation best reduces the patient’s risk for a wound infection. Open fractures are unique in the ED in that they require quick, high-volume irrigation before going to the operating room for more definitive wash-out. Often times a 30 mL syringe and 18-gauge angiocatheter is too cumbersome and slow for high-volume, high-pressure irrigation. […]
Must-know toxicology website for emergency physicians
With recent discussion about the potential closing of California Poison Control Centers due to budget cuts, I suddenly became shockingly aware of how much Emergency Departments depend on these centers for assistance. They are always so knowledgeable and helpful in managing various ingestions and poisonings. […]
Trick of the Trade: Peritonsillar abscess needle aspiration
How do you drain a peritonsillar abscess? When evaluating a patient with a sore throat and “hot potato voice,” peritonsillar abscess (PTA) is at the top of the differential diagnosis list. As with all abscesses, the definitive treatment involves drainage of pus. This can be done either by incision and drainage or, more commonly, by needle aspiration. […]
Trick of the Trade: Hair apposition technique (HAT trick)
Scalp lacerations over hair-bearing areas require wound closure, usually with staples. An alternative technique is the Hair Apposition Technique, also known as the HAT trick [1, 2]. This technique provides a more cost-effective, faster, and less painful approach to scalp laceration repair. Imagine the scalp hairs as suture ties already embedded in the skin. […]
Trick of the Trade: Reverse sugar tong splint
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
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
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. […]