Tag Archives: procedure

quick exposure with trauma shears: cut & tear

19 May

something I learned by trial & error and watching others along the way, but nicely addressed in this EMT Spot blog post:

NOT ROCKET SCIENCE:

cut at the edges (hemmed areas like the cuffs, collar, waist, etc)

tear with your hands (most fabrics will tear along that line fairly well)

 

quicker than cutting down each entire sleeve/pant leg

– less likely to cut through cords/leads/IVs, since there’s less cutting

 

 

BONUS TIPS:

– to remove shoes, cut the laces, and/or cut down the sides

be careful when cutting near pockets (a cloud of white powder in the resus bay complicates things)

cut around penetrating trauma holes in clothing (may be useful evidence)

– if pt moveable (e.g. not immobilized), cut midline at collar in front and back, then pull from the sides.

 

REMINDER:

– once you’re done with the assessment, cover ’em back up 

 

There you go.

 

References: EMT spot blog + pictures

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dermabond over steri-strips?

12 May

quick tip for laceration repair:

first apply steri-strips to approximate the wound,

then dermabond overtop the steri-strips for added strength for the closure.

 

bonus tip from personal experience: dermabond the ends of the steri-strips as well (had one drunk patient pick at the edges of the strips, which made it easier to lift-off the dermabond as well).

 

makes sense in theory (others have sutured over the steri-strips), found others who’ve tried this on a couple blogs, but otherwise the internet and PubMed are relatively bare on this potential technique

 

if you have any personal experience, or know of any sources for this use, please hit us up in the comments section.   Thanks!

 

References: blog post 1, 2, picture

visual aid: soft-tissue ultrasound

7 May

(apologies for the layoff between posts; busy time lately, but should be back into a rhythm)

some nice images via this April E-Med Journal article (for when you next need to determine if there’s something there to I & D):

Arrows (top to bottom) indicate: epidermis, subcutaneous tissue, muscle, bone

 

to help differentiate the sometimes difficult to distinguish (left to right): cellulitis, abscess, lymph node

 

References: emed journal article + pictures

syringe TMJ reduction

16 Apr

cool trick from a 2014 JEM article:

 

TMJ dislocation:

  • commonly from excessive mouth opening (e.g. yawning, laughing)
  • anterior TMJ dislocations most common (non-traumatic)

 

Study:

  • 30/31 successful reductions (all anterior dislocations)
  • 77% took < 1 min

Technique:

  • take 5-10 mL syringe
  • pt gently bites down on syringe (placed across molars)
  • ask pt to roll syringe back & forth

 

Benefits:

  • hands-free (no bite risk to provider)
  • quick
  • no procedural sedation needed

 

Seems pretty cool.  Add it to the toolbox.

 

References: JEM article; picture

neat trick: morgan lens for lateral canthotomy

9 Apr

from March’s ACEP Now:

couple neat tricks to keep in your back pocket for the rare but nerve-wracking procedure

 

LATERAL CANTHOTOMY, TIP 1:

place a Morgan lens to protect the globe from iatrogenic rupture

risk: corneal abrasion

benefit: less likely to poke the globe

ACEP_pg18c

LATERAL CANTHOTOMY, TIP 2:

bent paper clip to hook/retract the eyelid bluntly

easy to find, low-cost

 

There you go.

 

References: ACEP Now article + picture from article

suture through Steri-strips

19 Feb

nice trick for wound repair via January’s ACEP Now, especially if the patient has thin skin:

 

SUTURE THROUGH STERI-STRIPS:

basic idea: if the skin is so thin that suture would just tear through it when adding tension to approximte the wound edges, use the steri-strips to “thicken” the skin, so you can now anchor the sutures without tearing through anything.

2 ideas:

1) use the Steri-strips to bring the wound together, then suture through ’em

2) don’t use the Steri-strips across the wound, but rather just as an added layer near the wound edges to give a “thicker skin” to suture through.

Neat ideas. Add it to the toolbox.

 

References: ACEP Now article + pictures; original 2011 article for idea 1

visual aid: knee arthrocentesis

20 Jan

if you’re looking for a 60-second refresher on how to tap a knee, here are some handy pictures and video references:

knee1

 

if you only have 30-seconds, tune in at the 2:40 mark for some landmark refreshers.

 

HANDY TRICK (from a recent ALiEM post):

  • use one of your usual IV needles, then you can leave in the angiocath (plastic only) and remove the needle, for improved comfort/safety, especially if changing out syringes.

 

 

if you want to see a tap using a 6-inch spinal needle, check out this video 

  • 2-second takeaway: with enough swelling, sometimes the joint space can be quite far from the skin surface

knee2needle

 

References: NEJM procedure video; mellick video; ALiEM post