An IV drug user accidentally breaks off a 25-gauge needle in his/her forearm and presents to your ED for needle foreign body removal. How can you minimize the degree of trauma to the patient? How can you minimize the number of incisions made in order to find and remove this “needle in a haystack”?
The technique for abscess drainage traditionally is incision and drainage (I&D). In August 2012, I wrote about incision and loop drainage (I&LD), which it seems has gained popularity over time with similar outcomes. This technique involves using a sterile vascular loop, which is thin and long enough to form a loose knotted loop. The video below by Dr. Rob Orman reviews the steps. But, what if you don’t have a vascular loop in the ED?
General principles of fracture reduction involve axially distracting or pulling on a fracture fragment and pushing the piece back into anatomical alignment. This can be seen in the video below (automatically starts at 2:25 for the actual procedure). What if this approach doesn’t work? The fracture fragment remains immobile despite your best efforts.
This post is about an editorial comment by Dr. Richard Levitan on an article (1) about pulmonary critical care doctors performing intubations in the ICU (2). The study states that pulmonary critical care doctors can successfully perform this procedure. Dr. Levitan reports that intubation in elective anesthesia has a success rate between 98-99%, but when failure occurs the consequence can be catastrophic. The initial success rate of beginners is usually 50%, and it takes about 50 attempts in elective intubations to be 90% proficient.
Dr. Matt Borloz (Carilion Clinic) recently emailed me his recent trick in fixing a persistently leaking paracentesis site. Read about his experience:
A patient with advanced alcoholic cirrhosis with ascitic fluid leaking from a paracentesis puncture site from a procedure done 2 days prior. Dermabond had initially been applied post-procedure, but it had come loose, and ascitic fluid had been saturating dressing after dressing.
You are finishing up a successful subclavian line procedure. You insert the straight-needle suture needle through the skin to secure the line. When trying to pull it out, you accidentally poke yourself!
This is actually a common scenario for a needlestick injury. Although many central line kits now have curved suture needles, many still have straight needles. How can you avoid a needlestick?
Large-sized abscess often have pus trapped in deep crevices and pockets. Irrigation can help express the pus. How can you set up a high-volume irrigation system?