Tag Archives: video

modified valsalva maneuver (quick reference)

12 Jan

for a more in-depth look, check out last May’s ACEP Now article.

brief highlights:

  • 428 patient study
  • modified valsalva maneuver
    • forced strain (e.g. blow into 10 cc syringe)
    • lie patient flat
    • elevate legs to 45 degrees x 15 seconds
  • return to sinus rhythm at 1 minute:
    • 43% with modified valsalva
    • 17% standard valsalva (strain x 15 sec, no position change)
    • NNT = 4


quick visual aid (start at the 1:17 mark if short on time):


There you go.  Add it to the toolbox.

References: ACEP Now article; video


cool resource: lacerationrepair.com

5 Jun

came across this website, which has a number of handy blog posts and procedure videos on a variety of laceration repair techniques.  Great for the novice learner, with added tips/tricks (subculticulars, nailbed repair, thin skin, etc.) for the experienced practitioner, too.

One highlight that I use quite often: V to Y conversion

Basically, for a big V-shaped lac, the goal is to approximate the corner/apex first, then the rest becomes easy.


  • often needs higher tension, so start it like a horizontal mattress
  • throw a subcuticular around the corner/apex
  • bring it back like finishing up the horizontal mattress.
  • voila!


If you only have 60-seconds: Start at the 0:40 mark.


Just one example, but a good thing to have in the back pocket.

Keep the site in mind as a resource, too. Check it out at your leisure.


References: lacerationrepair.com (+ picture & video).


visual aid: Seidel sign

3 Apr

(repost, but a good timely refresher)


look for a Seidel’s sign: leaking fluid from the eye/globe on fluorescein exam



came across these nice videos on the magical internet, check out the first video if you can only spare a few seconds.  check out the 2nd video for some voiceover and a little more detail.




References: video 1; video 2



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:



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



References: NEJM procedure video; mellick video; ALiEM post


supraclavicular approach to a subclavian line

4 Mar

some nice tips for a less commonly used (but good to know) approach to the subclavian central line.

Some tips from a July EMN article:


best with ultrasound

+/- Trendelenburg position

first find the IJ (internal jugular vein)

IJ is compressible; usually oval or triangular (vs the more circular carotid, with its thicker walls)

trace it inferiorly to the supraclavicular fossa, see where it meets the SCV (subclavian vein) — [spare 30 seconds to watch the youtube video below, starting at the 1 min mark, to see this]

AVOID the pulsatile subclavian ARTERY (duh)

in-plane approach is handy, helpful [spare 30 sec to watch this, too, starting at the 2:30 mark]

References: EMN article + picture; youtube video




video review: emergent pericardiocentesis

20 Feb

Cribbed from this somewhat long but still useful NEJM procedure video (if you only watch 3 minutes, start at the 5:30 mark):


ultrasound guided (subxyphoid vs parasternal), ECG monitored (alligator clip to spinal needle), or blind approach (ballsy)

insert spinal needle through skin with stylet in place (avoids tissue biopsy), then take stylet out and advance with syringe attached

3-way stopcock between needle & syringe is handy for drainage assist

blind approach: subxyphoid, 45 degree angle, aim toward left shoulder

ECG-clip approach:

  • watch for ST elevations (this is too far–you’re touching the myocardium)
  • withdraw a bit until no ST elevations, then try to aspirate/reapproach



References: NEJM youtube video


no-cut ring removal

11 Feb

quick tips from this handy youtube clip from the ALiEM educational video series (if you only watch 30 seconds, start at the 2:30 mark)


take the elastic strap from an oxygen facemask

wrap it around the finger to compress

squeeze it under the ring

unravel and celebrate

There you go.

References: ALiEM youtube clip