1. San Francisco High Risk EM Emergency Procedure tricks
By Dr Michelle Lin Assoc Prof San Francisco General Hospital

2. How to not miss scalp wounds
LED light
Manual palpation
Irrigate wound – cut out tray to fit neck/head (like at hairdressers)

3. Modified Hair Apposition Technique (HAT) trick
Uses 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

4. Retracting swollen eyelid

5. Retracting swollen eyelid

6. If eyelids too swollen? Use bent paperclip retraction

7. How to secure avulsed tooth

8. Tissue adhesive and nasal bridge from N95 resp mask

9. Faster preg test than serum HCG
2-3 drops blood in urine pregnancy test
Wait full 5 minutes
Just as sensitive as urine
Consider serum testing only as clinically indicated

10. V-technique for finding femoral vein (thumb at pubic tubercle, index at ASIS V= femoral vein site

11. In obese pts get someone to retract abdominal wall so don’t approach too low

12. Difficulty with chest drain insertion? Use bougie like a stylet

13. EJ line Mandible gets in the way?
Bend jelco at proximal 1/3 to get shallow angle to cannulate with

14. Guidewire problems during 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

15. Radial gutter splint for 2nd MC # Cut POP from snuffbox to fingertip then fold over 2nd finger
Folds over dorsal and volar aspect of 2nd finger
Sits at base of thumb

16. Distal radius # -use a reverse sugar tong splint
Measure from knuckle to past the elbow
Cut at halfway fold almost all the way through
This will sit at the thumb web, and the ends fold at the elbow

18. Traditional technique for anterior hip dislocations

19. Captain Morgan technique for anterior hip dislocations (see on YouTube)

20. Ring removal
Wrap string from distal finger to proximal (on top of ring)
Wait minutes then remove ring
No need for cutting
Now where to find string?

22. How to remove metallic FB?
Use a rare earth magnet
Even from the cornea!

23. Rare earth magnet

24. How to reduce a rectal prolapse?

25. Apply sugar over the prolapse
Apply sugar over the prolapse. Osmotically draws water out of the prolapse