Date post: | 26-Mar-2015 |
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San Francisco High Risk EM San Francisco High Risk EM Emergency Procedure tricksEmergency Procedure tricks
By Dr Michelle Lin Assoc Prof San Francisco General Hospital
How to not miss scalp woundsHow to not miss scalp wounds
LED lightManual palpationIrrigate wound – cut out tray to fit
neck/head (like at hairdressers)
Modified Hair Modified Hair Apposition Technique Apposition Technique
(HAT) trick(HAT) trickUses opposing hair strands + adhesive
• One full 360o revolution twist of hair
• Apply adhesive at twisting point
• Repeat this along length of wound
• Do NOT over-twist the hair.
• Do NOT tie a knot.
• Good for less reliable patients
Retracting swollen eyelidRetracting swollen eyelid
Retracting swollen eyelidRetracting swollen eyelid
If eyelids too swollen?If eyelids too swollen?Use bent paperclip retractionUse bent paperclip retraction
How to secure avulsed toothHow to secure avulsed tooth
Tissue adhesive and nasal Tissue adhesive and nasal bridge from N95 resp maskbridge from N95 resp mask
Faster preg test than serum Faster preg test than serum HCGHCG
2-3 drops blood in urine pregnancy testWait full 5 minutesJust as sensitive as urineConsider serum testing only as clinically
indicated
V-technique for finding femoral veinV-technique for finding femoral vein(thumb at pubic tubercle, index at ASIS(thumb at pubic tubercle, index at ASIS
V= femoral vein siteV= femoral vein site
In obese pts get someone to In obese pts get someone to retract abdominal wall so don’t retract abdominal wall so don’t
approach too lowapproach too low
Difficulty with chest drain insertion? Use Difficulty with chest drain insertion? Use bougie like a styletbougie like a stylet
EJ lineEJ line
Mandible gets in the way?Bend jelco at proximal 1/3 to get shallow
angle to cannulate with
Guidewire problems during Guidewire problems during CVC insertion?CVC insertion?
Guidewire not feeding or stuck– Reaspirate for blood– Flatten needle angle– Twirl guidewire
Lost the guidewire sheath– Temporarily straighten the ‘j’ end by
straightening guidewire
Radial gutter splint for 2Radial gutter splint for 2ndnd MC # MC #Cut POP from snuffbox to fingertip then fold Cut POP from snuffbox to fingertip then fold
over 2nd fingerover 2nd finger
Sits at base of thumb
Folds over dorsal and volar aspect of 2nd finger
Distal radius # -use a reverse Distal radius # -use a reverse sugar tong splintsugar tong splint
Measure from knuckle to past the elbowCut at halfway fold almost all the way
throughThis will sit at the thumb web, and the ends
fold at the elbow
Traditional technique for Traditional technique for anterior hip dislocationsanterior hip dislocations
Captain Morgan technique for Captain Morgan technique for anterior hip dislocationsanterior hip dislocations
(see on YouTube)(see on YouTube)
Ring removalRing removal
Wrap string from distal finger to proximal (on top of ring)
Wait 5- 10 minutes then remove ringNo need for cuttingNow where to find string?
How to remove metallic FB?How to remove metallic FB?
Use a rare earth magnetEven from the cornea!
Rare earth magnetRare earth magnet
How to reduce a rectal How to reduce a rectal prolapse?prolapse?
Apply sugar over the prolapse. Apply sugar over the prolapse. Osmotically draws water out Osmotically draws water out
of the prolapseof the prolapse