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

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 don’t 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 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

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 5- 10 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 Apply sugar over the prolapse. Osmotically draws water out of the prolapse