visual aid: breech delivery

the most commonly referenced delivery maneuver seems to be the Mauriceau‐Smellie‐Veit maneuver:

the basics to get to that point seem to be:

–wait till you see the popliteal fossa, then sweep/deliver the leg

–wait till you see the scapula border, then rotate gently and sweep/deliver the arms

–wait till you see the nape of the neck, then deliver with the MSV maneuver

 

quick snapshot visual aid:

 

quick video visual aid (relatively short, with decent audio):

 

There you go. Add it to the emergency toolbox.

 

References: guidelines, photo visual, video visual

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NG tube utility in bowel obstruction

another food-for-thought tidbit after a bit of a long layoff…

 

Best BETs from the Manchester Royal Infirmary. BET 1: Is routine nasogastric decompression indicated in small bowel occlusion?

–found all of one useful/relevant paper (below)

 

Fonseca et al: Routine nasogastric decompression in small bowel obstruction: is it really necessary?

• Key points:
  • 65-80% of SBOs (small bowel obstructions) are treated non-operatively (bowel rest, IVF, obs)
  • NG (nasogastric) tube often used for decompression
  • NG tube complications can include: pneumothorax/perf, pneumonia, nasal trauma/infection, patient discomfort, etc.
• Retrospective study highlights:
  • 290 patients >18 yo with SBO
  • causes included adhesions, malignancy, unknown (excluded incarcerated hernias)
  • 235 patients got NG tubes (so 55 didn’t)
  • NG tube was not associated with avoidance of surgery
    • 37% (87/235) with NG tubes needed OR intervention
    • 24% (13/55) without NG tube needed OR intervention
  • Days to resolution (average)
    • 3.55 days in NG tube group
    • 1.67 days in non-NG tube group
  • Hospital length of stay (average)
    • 10.16 days in NG tube group
    • 3.18 days in non-NG tube group
    • similar trend excluding the patients who needed OR intervention
  • Significantly higher rate of pneumonia in the NG tube group (11.59% vs. none, P=0.007)
  • author conclusion: “…we recommend the judicious use of NGT, especially in patients presenting without emesis.”

 

old article, but often cited: Singer et al: Comparison of patient and practitioner assessments of pain from commonly performed emergency department procedures

• most painful procedures according to patients (in descending order)
  • nasogastric intubation
  • abscess drainage
  • fracture reduction
  • urethral catheterization

 

Food for thought.

 

References: Best bet article, Fonseca article, Singer article, picture

visual aid: Davos shoulder reduction

here’s a couple quick visuals to help add this shoulder reduction technique to your bag of tricks (which worked in 86/100 patients in one study):

Note: if you only have 1 minute, start watching at the ~1:30 mark.

 

as opposed to the video, the article suggests wrapping the elastic bandage around the leg as well, which means you don’t have to rely as much on the patient to keep their arms in position (makes sense to me).

 

There you go. Add it to the toolbox.

 

References: article; video; picture

 

visual aid: slit lamp tutorial

a nice quick video tutorial on the slit lamp exam from this old ALiEM post:

if you only have a couple minutes, the ~2:00 to 4:00 minute mark are nice reminders of a few knobs and how to adjust the level and light window.

also, there’s a nice example of cell & flare at the ~5:30 mark.

Go forth, look at eyeballs.

 

References: ALiEM post (with other eye exam videos also)

IO craniotomy?

back after a bit of a layoff with a bit of an interesting, if maybe not ready for primetime procedure idea, via this Austrailian resus blog:

basically, in the setting of an expanding intracranial hematoma, evacuating the pressure to temporize (the alternative being herniation, then death).

while burr holes are preferred, if you have nothing else, interesting to see this on the horizon as a potential option.

 

References: resus blog post & photo

ECG [anatomical] visual aid

quick anatomical reference for your ECG thought process (particularly for browsing contiguous leads), via an old emDOCs post:

for your reference, a simple anatomical diagram below:

The emdocs post also has some nice echo videos and many more photos from different perspectives, if you need some additional spacial orientation.

 

References: emdocs post; coronary artery photo

ultrasound visual aid (part 2): glove assist

on a recent post, referenced the idea of using an IV saline bag to ultrasound through to visualize tricky irregular and superficial surfaces (e.g. hand/digits).  

Here’s a handy visual aid for the same idea, only using a water-filled latex glove (via an 2016 emed journal article):

Add it to the toolbox.

References: emed journal article (& photo)