Archive | April, 2017

quick tip: easy fluorescein staining

28 Apr

via a recent post from the Procedural Pause:pp20fluoro20clinical20pearl

use a saline ‘bullet’ (dropper), drip a little saline on the fluorescein strip, then draw it back up.

 

handy for peds, or for squirmy adults, too

 

 

I’ve also seen the strip dropped in the back of a 10 cc syringe, or a saline flush used similarly as with the dropper above (see this ALiEM post for more).

dab-650x464

 

There you go. Add it to the toolbox.

 

References: procedural pause post, ALiEM post

 

 

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vomiting during intubation? tube the esophagus

13 Apr

quick handy tip from this EMCRIT podcast for a vomit (or blood) laden oropharynx during intubation:jan_08_jems_intubation101

blindly (since you can’t see anything) insert an ETT; if it happens to be tracheal, great.

more likely, it’ll be in the (esopha)gUs.  LEAVE IT THERE.  you can intubate around it shortly, and you now have a landmark to intubate over. 

now here’s the tip: INFLATE the cuff on the esophageal ETT.  Also remember to tilt the now vomit-spewing ETT to the side, but this is now an outlet for the blood/vomit that won’t obscure your DL view

now, suction, and intubate the trachea.

 

Easy concept, handy tip.  Add it to the toolbox.

(check out the podcast for some more tips, but I thought that was the handiest).

 

References: EMCRIT podcast; picture