Trick of the Trade: Nasal cannula oxygenation during endotracheal intubation

You are managing a 300-pound patient with a long history of severe COPD, who now requires intubation because of a pneumonia and COPD exacerbation. You anticipate that the patient may be a difficult airway intubation and may desaturate quickly during laryngoscopy. While you are setting up to orotracheally intubate this patient, you preoxygenate this patient as best as you can with a non-rebreather mask.

What can you do to prolong the patient’s time-to-desaturation so that you aren’t as rushed to place the endotracheal tube?

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By Michelle Lin, MD|2019-01-28T22:35:50-08:00Oct 25, 2011|Tricks of the Trade|

One of the indications for nasogastric (NG) tube placement is to instill fluids or medications. This may be saline or water for NG lavages or charcoal. You can manually push fluids into the NG tube via a 60 cc syringe, but this may take a long time for large volumes.

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By Michelle Lin, MD|2016-11-11T18:52:19-08:00Aug 16, 2011|Tricks of the Trade|

Trick of the Trade: Ring removal from a finger

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.

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By Michelle Lin, MD|2016-11-11T18:53:07-08:00May 25, 2011|Tricks of the Trade|

Trick of the Trade: Temperomandibular (TMJ) dislocation

Mandible, or TMJ, dislocations occur when the patient excessively opens the mouth, such as in a yawn. They are typically bilateral and are difficult to relocate because of masseter and medial pterygoid muscle spasm. You can relocate the condyles back into the TMJ space with gentle but firm intraoral pressure inferiorly and posteriorly. Often it requires some sedation to help relax the muscles of mastication.

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By Michelle Lin, MD|2019-01-28T22:49:39-08:00May 4, 2011|ENT, Tricks of the Trade|

Trick of the Trade: Steristrip-suture combo for thin skin lacerations

Lacerations of elderly patients or chronic corticosteroid users can be a challenge because they often have very thin skin. Sutures can tear through the fragile skin. Tissue adhesives may not adequately close the typically irregularly-edged laceration.

How do you repair these lacerations?
Do you just slap a band-aid on it?

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By Michelle Lin, MD|2019-11-29T18:57:44-08:00Mar 30, 2011|Geriatrics, Trauma, Tricks of the Trade|

Trick of the Trade: Benzoin for opening traumatic, swollen eyelids

Patients who sustain facial trauma often have swollen eyelids. They may be so swollen that it is impossible to pull back the eyelids for an ocular exam. You use one of our “Tricks of the Trade”ideas and attempt to “roll” the upper eyelid using the Q-tip trick (above).

Fresh blood on the face, however, makes the Q-tip a little slippery along the upper eyelid, preventing an adequate view of the eye itself.

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By Michelle Lin, MD|2016-11-25T15:43:21-08:00Mar 23, 2011|Ophthalmology, Tricks of the Trade|

Trick of the Trade: Heat it up!

What is it about heat that makes everything feel better? Fireplace, hot tub, heat packs, electric blankets, and hot chocolate have got to be the best inventions EVER.

How can we apply this in Medicine?

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By Michelle Lin, MD|2026-03-12T08:21:43-07:00Mar 9, 2011|Tricks of the Trade|

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