Presentation on theme: "San Francisco High Risk EM Emergency Procedure tricks By Dr Michelle Lin Assoc Prof San Francisco General Hospital."— Presentation transcript:
San Francisco High Risk EM Emergency Procedure tricks By Dr Michelle Lin Assoc Prof San Francisco General Hospital
How to not miss scalp wounds LED light Manual palpation Irrigate wound – cut out tray to fit neck/head (like at hairdressers)
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
Retracting swollen eyelid
If eyelids too swollen? Use bent paperclip retraction
How to secure avulsed tooth
Tissue adhesive and nasal bridge from N95 resp mask
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
V-technique for finding femoral vein (thumb at pubic tubercle, index at ASIS V= femoral vein site
In obese pts get someone to retract abdominal wall so dont approach too low
Difficulty with chest drain insertion? Use bougie like a stylet
EJ line Mandible gets in the way? Bend jelco at proximal 1/3 to get shallow angle to cannulate with
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
Radial gutter splint for 2 nd MC # Cut POP from snuffbox to fingertip then fold over 2nd finger Sits at base of thumb Folds over dorsal and volar aspect of 2 nd finger
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
Traditional technique for anterior hip dislocations
Captain Morgan technique for anterior hip dislocations (see on YouTube)
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?
How to remove metallic FB? Use a rare earth magnet Even from the cornea!
Rare earth magnet
How to reduce a rectal prolapse?
Apply sugar over the prolapse. Osmotically draws water out of the prolapse