• scalp laceration

Trick of the Trade: Modified HAT trick revisited

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

I finally tried the Modified HAT (Hair Apposition Technique) trick for the closure of scalp lacerations. I have used the traditional HAT trick multiple times but not the modified technique. What's the difference? Instead of using your fingers, the modified approach involves the use of two instrument clamps to help twist and pull the hair strands taut. It turns out that this makes a huge difference, especially for short hairs. The clamps allow you to grab the hair strands so much more securely, before instilling a tissue adhesive at the twisting points. The nice added benefit was that my chubby [...]

  • Thrombectomy

Paucis Verbis card: Acute limb ischemia

By |Categories: ALiEM Cards, Cardiovascular|

Acute limb ischemia (ALI) is a true vascular emergency. It doesn’t occur as frequently as the more high-profile conditions as cerebrovascular accidents and acute myocardial infarcts, but it portends similarly high morbidity and mortality risk. How do you stage a patient with ALI, based on the Rutherford classification system? What is the ED treatment plan? Should this patient go to Interventional Radiology or the Operating Room for more definitive management? […]

  • capnogram capnography shark fin normal

Paucis Verbis card: Procedural sedation and analgesia

By |Categories: ALiEM Cards, Tox & Medications|

From time to time, our patients need moderated and deep sedation in order to tolerate painful procedures such as joint reductions or incision and drainage procedures. There are many medications available to us including some newer ones such as Ketofol and Dexmedetomidine. This week’s Paucis Verbis is a reference card to remind us of the importance of Airway Assessment and help us calculate the medication doses. […]

  • Prescription Pad

Trick of the Trade: Prescribing opiates

By |Categories: Tox & Medications, Tricks of the Trade|

  As emergency physicians, we are experts in pain control. We frequently write opiate prescriptions for patients being discharged home. Unfortunately, an occasional patient tries to forge my prescription. At times, I get a call from pharmacy for prescriptions that were suspiciously written. For instance several years ago, I had someone try to forge 100 tablets of “Mophine”. […]

  • Strep

Paucis Verbis card: Strep pharyngitis

By |Categories: ALiEM Cards, ENT, Pediatrics|

Have you heard of the Modified Centor Score for strep pharyngitis? Interestingly, it has been validated in adults and children. The methodology builds on the traditional Centor Score by incorporating the patient’s age, because this disease is more prevalent in kids than adults. In fact, you actually lose a scoring point if you are older than 44 years old. […]

  • Mandible Tongue Blade

Trick of the Trade: A tongue blade is as mighty as an xray

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

Patients often present to the Emergency Department for mandibular blunt trauma. Usually these patients have soft tissue swelling at the point of impact. In mandibular body fractures, the fracture line often extends to the alevolar ridge. This may cause a gap between a pair of lower teeth. In patients with jaw pain, mild swelling, and normal dentition, is there a way to avoid imaging these patients to rule-out a mandible fracture? […]

  • Laryngoscope

Paucis Verbis card: Rapid Sequence Intubation

By |Categories: ALiEM Cards, Tox & Medications|Tags: |

The key to success in performing procedures is preparation. This is especially true for endotracheal intubations in the Emergency Department where things are chaotic. Strategic planning and anticipation of obstacles during rapid sequence intubation (RSI) are key principles to avoiding complications. […]

  • OKN drum

Trick of the Trade: OKN drum to test psychogenic coma

By |Categories: Neurology, Tricks of the Trade|

Occasionally, emergency physicians see patients who present because they are unresponsive despite normal vital signs and an otherwise normal exam. You detect no drugs or alcohol on board. You suspect a psychiatric or malingering etiology, but aren’t sure. They seem non-responsive to voice and minimally responsive to very painful stimuli. Is this a case of psychogenic coma or true coma (with bilateral hemispheric dysfunction)? What test can you do to reassure yourself that this may indeed be psychogenic coma? […]