Resolve Otitis Externa Fast with an Ear Wick
​Emergency providers expeditiously sift and sort patients on their shifts and streamline procedures like how to place an ear wick in a patient with otitis externa, a quick and useful procedure for a patient who will reap the rewards.Standard ear wicks. The material is made from a dehydrated sponge composed of hydroxylated poly(vinyl acetate). It increases in size when liquid is applied. Photo by M. Roberts.Otitis externa can cause significant swelling, irritation, pruritis, and pain to the ear canal. Occasionally, the canal is so swollen it may be difficult to administer ear drops. An ear wick can be inserted between the...
Source: The Procedural Pause - June 2, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Part Two: Mastering Wrist Arthrocentesis
​We discussed the initial approach to the red, hot swollen wrist joint last month, and this month we focus on arthrocentesis of the joint with a full video of the procedure, including ultrasound and joint aspiration.A swollen, painful wrist that is hot to the touch with scant erythema is concerning for septic arthritis. The patient had multiple Band-Aids on his fingertips from blood glucose testing for diabetes, which increased his chances of having a septic joint with the punctures serving as an entry site for infection. Photo by Martha Roberts.The ProcedureIdentify the swollen joint, review the differential diagnosis, ...
Source: The Procedural Pause - May 1, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Part One: Tapping the Wrist
​The wrist is not commonly aspirated in the emergency department, but emergent arthrocentesis may be indicated for extreme or concerning cases, and tapping the wrist to determine the underlying pathology or relieve pain may be of great value. The synovial fluid from the joint space can be analyzed for crystals, infection, and blood. This information may help determine the overall plan and aid in decision-making and consultation. The ultimate treatment plan may include admission, intravenous antibiotics, multiple aspirations, and even surgical washout.A swollen, painful wrist that is hot to the touch is concerning for sep...
Source: The Procedural Pause - April 1, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Paracentesis: The Procedure
Discussion: The Z-track method minimizes fluid leakage from the puncture site. Injecting medication into the skin using this method is important to preventing post-procedure leaking. Once a needle has entered subcutaneous tissue and muscle, it opens a track that may not reseal immediately. There are also studies suggesting that Z tracks may reduce pain during injection. We suggest using the method during your paracentesis procedure.Z tracks are used for all kinds of intramuscular injections and can be applied to other sites on the body. Pull and press the skin and tissue 2 cm caudad to the deep abdominal wall and insert th...
Source: The Procedural Pause - March 3, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Using Ultrasound for Paracentesis
​Paracentesis can be a quick and simple procedure with the right equipment and a well-rehearsed approach. It's important to practice this skill in the procedure lab and to familiarize yourself with the kit in your department a few times a year. This month, we focus on paracentesis set-up and basics, and next month we will review the nuts and bolts of completing the procedure.Important equipment for paracentesis: Five or six collection bottles, antiseptic prep, and a paracentesis kit. Consider longer needles for abdominal walls thicker than 2.5 cm.Grab the ultrasound and a pen. Position your patient at a 45-degree angle, ...
Source: The Procedural Pause - February 3, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Ride the Fluid Wave Before Performing a Paracentesis
​Before you break out the bottles for a paracentesis, you may want to consider doing a test for ascites. Many procedures require executing an old-school test before even looking at a result or grabbing an ultrasound machine. Knowing what to look for on a physical exam may guide your practice and intervention dramatically. Using noninvasive tools first could help your patient avoid other tedious or unnecessary testing, which may also result in lost time. Incorporating ultrasound into your practice may also help you nail a diagnosis or allow you to perform a procedure better than you expected.A markedly distended abdomen d...
Source: The Procedural Pause - January 2, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Treating Fingertip Amputations
​Fingertip injuries and amputations are common in the emergency department, often occurring on weekends when consultants are not available. Some experienced physicians may consider rongeuring distal tuft amputation injuries, but simple closure and expert consultation for more difficult cases are suggested.A fingertip amputation within zone III involving total amputation of the distal tip, fingernail, matrix, and tuft. Photos by M. Roberts.Care of fingertip amputations in the ED should focus on removing debris and cleaning the wound as best as possible, closing the wound using available skin, bandaging and splinting for c...
Source: The Procedural Pause - December 5, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Evacuating the Nefarious Subungual Hematomas
​Subungual hematomas can be a terror. They are painful, ugly-looking, nefarious, and sometimes confusing. The ultimate goal is to drain the accumulated blood and relieve the painful pressure.The best intervention is easy and straightforward: Leave the nail in place, and evacuate the blood under it. (Hand Surg. 2012;17[1]:151; Am J Emerg Med. 2006;24[7]:875; Emerg Med J. 2003;20[1]:65, http://bit.ly/2mHV1cO.) Then, provide excellent discharge information without prescribing antibiotics.A subungual hematoma in a 21-year-old man who slammed his thumb in a car door about 12 hours before ED arrival. Photo by M. Roberts.Distal...
Source: The Procedural Pause - November 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Figure-of-Eight Sutures for Bleeding Varicose Veins
​The figure-of-eight suture is a fascinating technique, often used in unique cases. The stitch is extremely secure and easy to place. It can be used to save time during long, complicated repairs and to create additional strength in high-tension areas. The figure-of-eight stitch can be modified to bring skin edges together or close off small bleeding arteries, varicose veins, or even bleeding hemorrhoids. Multiple figure-of-eight sutures can be used in a row.The idea is to use a single suture to surround a small area of tissue in a box shape to close a laceration or put pressure on a small site. Figure-of-eight sutures ca...
Source: The Procedural Pause - October 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Sharing Tension to Repair Chainsaw Injuries
​As autumn rolls around, many people are cutting wood for their fireplaces, which can precipitate chainsaw, axe, and saw injuries. These lacerations can be tricky to repair because they often bleed profusely and leave jagged edges. They may also be dirty and harbor foreign bodies such as wood chips, metal, and rust. They may even disrupt underlying tendons, ligaments, and bones. Amputations are uncommon, but do occur.Extremity injuries from chainsaws leave ugly, macerated skin disruptions and lacerations. Even chainsaws that are turned off may cause lacerations and puncture wounds. Most injuries affect the hands and legs...
Source: The Procedural Pause - September 3, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Getting the Toe Out of a Jam
Toe jam injuries are extremely painful because the feet have sensitive parts and a delicate anatomy. Patients, especially women, care about cosmetic results. EPs should consider the emergency concerns of foot wound closure and cosmetic results when attempting repair. More importantly, patients with neuropathies, diabetes, and vascular diseases warrant close attention to detail to prevent complications. High-risk patients can develop serious infections, which could result in the loss of a toe or limb. It might be excessive to call a plastic surgeon to consult on a foot wound, but it may be appropriate to consult podiatry or...
Source: The Procedural Pause - August 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Plain and Simple Ocular Punctal Plug Removal: Part II
​Ocular punctal plug removal is a straightforward procedure easily completed in the emergency department. Serious complications from punctal plug insertions are rare but sometimes seen.Left: A punctal plug in the upper lacrimal duct of the right eye, allowing for moisture balance from tear production. Right: The tiny punctal plug after it was removed. Photos by M. Roberts.Punctal plugs are placed in some or all of the lacrimal ducts by an ophthalmologist to treat chronic dry eye, and can be permanent or dissolvable. Plugs typically stay in place for three months or longer. (Am J Ophthalmol. 2007;144[3]:441.) The most com...
Source: The Procedural Pause - July 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Side Effects of Punctal Plugs: Part I
Dozens of pharmaceutical commercials about dry eyes play on television or the radio. Ophthalmologists often use punctal plugs, also called lacrimal duct plugs, for this diagnosis.Punctal plugs are tiny devices that fit snugly in the tear ducts or puncta of the eye. The plug completely blocks the duct and prevents tears from draining. This allows the moisture in the eye to stick around longer and lubricate the eyes. Patients rarely have major complications from the plugs, but they can fall out or slip out of position.Patients with dry eyes may have chronic aqueous tear deficiencies or have other ocular issues such as kerato...
Source: The Procedural Pause - June 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Bedside Ultrasound Has Potential to be the New Gold Standard for Pneumothorax
​Bedside ultrasound can be useful for identifying lung structures and assisting with chest tube placement. It can also be used to identify a pneumothorax and confirm chest tube placement post-procedure. Practice looking for signs, and make sure you can identify them in normal pediatric and adult patients. You may still need additional imaging such as chest x-ray and CT to confirm the diagnosis, but US yields immediate and accurate results.Check first for lung sliding, a simple yet convincing finding on US confirming that the lung is inflated. A thin, white line will be seen, which highlights the lung's pleural lining. It...
Source: The Procedural Pause - May 2, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Trocar during Times of Trauma
​Seventy-five percent of trauma injuries involve some kind of thoracic insult, a quarter of which need a procedural intervention like a chest tube. (Surg Clin North Am 2007;87[1]:95; http://bit.ly/2HaoX90.) Long-term illness, lung disease, and post-operative complications may cause pleural effusions or a pneumothorax, so treating these conditions quickly can significantly decrease patient morbidity and mortality. Other indications for chest tube placement include:Trauma: Pneumothorax, hemopneumothorax, or tension pneumothoraxLong-term illness: Pleural effusion (cancer, pneumonia)Infection: Empyema, purulent pleuriti...
Source: The Procedural Pause - April 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Essential Checklist for Ankle Dislocations
​Immediate relocation of ankle dislocations is necessary to preserve the vascular or neurological integrity of the lower extremity and relieve extreme pain. Literature reviews reveal that early reduction followed by a short period of immobilization (six to 12 weeks) and functional or physical rehabilitation produce good clinical outcomes. (Injury 2017;48[10]:2027).Left ankle dislocation from a football accident. Photo by M. Roberts.Ankle dislocations occur from blunt or traumatic incidents such as sporting events (football, gymnastics), motor vehicle crashes, falling, or jumping. Patients may state that their toes were p...
Source: The Procedural Pause - March 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Slit Lamp Made Simple
​The slit lamp is a straightforward and user-friendly machine designed to make ocular exams easy. All the buttons, knobs, and lights, however, can be intimidating. This should not dissuade practitioners from getting cozy, driving the joystick, and evaluating ocular issues.An ED slit lamp with an LED light and magnification power up to 40x. Photo by M. Roberts.ED slit lamps are designed to be a bit more basic in function than those found in an ophthalmologist's office. Many EDs may house more complex machinery, but the vast majority of microscope and light arm combination is set at one length with one lens and one to two ...
Source: The Procedural Pause - February 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Anoscope for Foreign Bodies in the Rectum
​Rectal exams are difficult for the patient and require true expertise. You cannot expect to complete a good rectal exam or remove a rectal foreign body without the correct information, good bedside relationship, and the right equipment.Ensuring your patient has confidence in your ability is vital. Take the time to get to know what equipment is available in your ED. It's important to know what to do before a patient comes to your department with a rectal complaint.Most departments have a box dedicated to the anoscope. It typically will have two handles for light sources and two sizes of obturators with casing. The items ...
Source: The Procedural Pause - December 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Atomizer and Naloxone: Life-Saving Treatment for Opioid ODs
​The atomizer is a handy tool to instill life-saving medication into the nose, and you should consider stocking them if you don't already. An atomizer can be used to administer naloxone and countless other drugs as well as for moderate sedation and pain control. Pediatric and adult patients alike can benefit from intranasal fentanyl or Versed. Studies on intranasal epinephrine for anaphylaxis also look promising, but it does require a higher dose—5 mg instead of 0.3 mg. (Asian Pac J Allergy Immunol 2016;34[1]:38; http://bit.ly/2Prpjhb.)The atomizer is easy to use and can be attached to any syringe. Each spray creat...
Source: The Procedural Pause - December 4, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Acute Angle Closure: Mastering Tonometry
​Identifying and managing disease often requires the delicate and skillful use of temperamental emergency department machinery. The ability to apply these may appropriately help determine a difficult diagnosis.Glaucoma, we all know, can cause blindness, and acute narrow angle glaucoma refers to the angles within the eye that are not as wide and open as normal. People with acute angle glaucoma have abnormal anatomy within the eye where the angle changes as the eye is dilated. This can cause blockages of fluid drainage from the anterior to posterior changes resulting in increased intraocular pressure. It ca lead to acute a...
Source: The Procedural Pause - November 9, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Ring Cutter to the Rescue
​It's a good idea to find the ring cutter in your department before you need it. Know where it is, what the box looks like, and if it's electric or manual. Some departments may even keep it in the PIXIS or medication dispensary machine. You will also want to know where you keep your vice grips, wire cutters, and spreaders.A patient with a hand injury must have his ring removed immediately. Lacerations, crush injuries, burns, degloving injuries, fractures, and even hand or finger contusions require prompt removal of any constrictive device. Swelling in the distal extremity can occur around the injury. The space in the han...
Source: The Procedural Pause - September 30, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Double Trouble: Both-Bone Fractures
​Both-bone forearm fractures may make you feel a little nervous. A completely crooked forearm is definitely a disturbing sight. Both-bone forearm fractures (especially of the midshaft) typically require surgical intervention, but relocation of bony injuries, regardless of site or complexity, is an important and necessary skill you need to know. Plus, you will be required to assist with sedation, reduction, and splinting when the orthopedic team is involved.​Correcting and stabilizing two bones (instead of one) may seem tricky, but we are going to help you do it right. This complex procedure should be done with orthoped...
Source: The Procedural Pause - August 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Almighty Hematoma Block for Wrist Fractures
This study found a "statistically significant difference during initial hours after fracture reduction and fixation so that pain intensity was less in elderly patients under hematoma block than patients who underwent general anesthesia in one and six hours after surgery." Most importantly, patients in the hematoma block group required less narcotic pain medication compared with the general surgery population.Experienced providers often know exactly where to inject anesthesia for hematoma blocks. Ultrasound-guided injection techniques, however, prove to be more accurate. Using ultrasound to identify the hematoma a...
Source: The Procedural Pause - July 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Nailed It!
​What do you do for a nail from a nail gun in the hand? This procedure is simple, but you have to worry about the aftermath. Complicated issues may arise post-procedure in the days to weeks after extraction, including retained foreign bodies, infection, fractures, disability, pain, nerve damage, tendon rupture, and cosmetic concerns.​Removing the nail is only half the battle. Proper removal, treatment, and follow-up should be considered with all foreign bodies in the skin, especially the hand. Being prepared for the possible aftershocks will help your patient have a successful recovery.A 23-year-old man with a nail fro...
Source: The Procedural Pause - June 1, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Let the Hand Take a Bath with Ultrasound for Foreign Bodies
​Some procedures are worth doing over and over because they are easy and fun. The bonus is they can improve outcomes for patients and prevent bouncebacks, costly follow-up exams, and prolonged pain and complications. This month we discuss the use of the ultrasound (US) water bath and bedside imaging for foreign bodies (FB). If you would like to see more about using ultrasound for FBs, see our previous blog post about wine glass in the foot. (http://bit.ly/2HSQLvZ.)​Bedside US is an exquisite technique that can be used to examine and explore numerous parts of the body without using radiation. This procedure uses a simpl...
Source: The Procedural Pause - April 30, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Weird and Wild: The Hidden Compartment Syndrome
​Compartment syndrome made it on our weird and wild list not only because it is uncommon but also because it is difficult to identify. It presents in strange ways, and is often missed the first time a patient seeks care. This rare but serious condition may result in permanent contractures or even loss of a limb. Complications from compartment syndrome escalate quickly if they're not treated promptly. Early recognition and treatment of this problem is imperative.The increased pressure in the space around certain muscles that creates compartment syndrome can be caused by fractures, bleeding, recent surgeries, burns, rhabdo...
Source: The Procedural Pause - April 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Curse of the Keloid
​Each month, we try to bring you a case that is laced with unexpected care techniques. Our hope is that our procedural pearls help enhance your practice. Procedures rarely change over time, but new techniques and equipment may help you tackle new challenges. Once you have mastered simple procedures like incision and drainage and suturing and splinting, you can move on to more advanced procedures.​This month we dare you to think outside the box and combine all your skills to help this weird and wild patient. We've said it before, and we'll say it again: It may not be an emergency, but it's an emergency to your patient.A...
Source: The Procedural Pause - February 28, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Weird and Wild: Back Piercing and Langers’ Lines
​A patient presented to the emergency department with a request to remove her back ring. Yes, that's right, her back ring. We were a bit confused at first by the piercing. The stud was placed in her back with no obvious way of removal. Our original thought was to send the patient to dermatology or even plastic surgery. The piercing certainly didn't qualify for emergency surgery or removal.​​​A 23-year-old woman with a back piercing in the left lower back. The underlying skin condition is not infectious. This is a classic example of tinea versicolor, and is not related to the piercing. It is a common fungal infectio...
Source: The Procedural Pause - January 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Weird and Wild: Piercing Problems, Tongue Rings, and TXA
​Some of our patients are total daredevils. This unique population keeps us on our toes. Our weird and wild series recently discussed laceration repair involving tattoos, but problematic piercings also present to the ED.​Traditional through-and-through piercing of the tongue body without complication. Photo: Creative Commons.An 18-year-old otherwise healthy woman presented to the emergency department with tongue swelling and mouth pain. Your first thought may be that this is an allergic reaction, but you quickly realize this is not the patient you expected. This patient just had her tongue pierced, and something has go...
Source: The Procedural Pause - January 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Taming the Tattoo
​What do you do when something weird and wild comes into your emergency department? This month, we mean lacerations over tattoos or body piercings. Cosmetic repair of injuries involving tattoos and piercings are important to our patients. We should ensure proper wound closure while preserving the underlying body art.Tattoos and piercings are ancient practices of body modification. This form of art appreciation continues to be a popular and important cosmetic alteration for many people. Body art ranges from ear piercings ($20-30 for earlobes) to extensive tattoos that cost thousands of dollars.Many have sentimental value ...
Source: The Procedural Pause - December 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Weird and Wild: Scalp Abscesses and Kerions
​Welcome back to the weird and wild, "what do I do with that?" series! We want to take you back to the magical land of abscesses. This scalp abscess case study and Procedural Pause pearl will help you relieve significant pain and decrease the risk for skin infections and complications. This case made it to our weird and wild list for being rare and interesting.​Scalp abscesses and kerions can be tricky and complicated. At first glance, they can appear small and harmless. They are often underappreciated for this reason, but require immediate attention. There are several types of wound infections and rashes tha...
Source: The Procedural Pause - November 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Wine Glass in the Foot: A Case Study
​Emergency department providers welcome the weird, the wild, the wonderful, and the unexpected. Routine chest pain workups and negative abdominal CTs occasionally bore us. Last summer we had the pleasure of meeting a man who was a line cook at a local restaurant. He came via ambulance for a foreign body in his foot. What we saw was unanticipated—he arrived with half a wine glass lodged in the sole of his foot.​ The stemware was lodged in the patient's foot, going through his shoe and sock. Photos by Martha Roberts.The patient was laughing and not in much pain. He said he had a high pain tolerance and could b...
Source: The Procedural Pause - October 2, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Short and Long Posterior Splints for Leg Injuries
​We use splints to help immobilize and stabilize injuries, but it's important to realize splinting also alleviates pain and edema and promotes healing until follow-up. If you are ever concerned that there is a fracture (even if it's not apparent on radiograph, i.e., navicular fractures), splint your patient before discharge. If you have the luxury of orthopedic consult in-house, talk to him before discharge.​Indications for Short Posterior Splint-Fractures of the distal tibia and/or fibula-Ankle dislocations-Severe sprains-Fractures of the talus-Fractures of the calcaneus-Foot fractures such as fractures of the fifth m...
Source: The Procedural Pause - September 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Losing (and Regaining) Your Grip
Tennis elbow, also known as lateral epicondylitis, is a painful and persistent problem that can be transient or chronic. The syndrome is caused by overuse of the elbow, although not always caused by one too many games of tennis.​Lateral epicondylitis is an inflammation of the tendons that join the forearm muscles to the outside of the elbow. Overused and abused tendons can be damaged or even destroyed. Performing the same repetitive motions over and over again can irritate and annoy the tendons, resulting in severe pain, tenderness, and even inability to use the affected extremity.Many treatments are available for latera...
Source: The Procedural Pause - August 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Losing (and Regaining) Your Grip
Tennis elbow, also known as lateral epicondylitis, is a painful and persistent problem that can be transient or chronic. The syndrome is caused by overuse of the elbow, although not always caused by one too many games of tennis.​Lateral epicondylitis is an inflammation of the tendons that join the forearm muscles to the outside of the elbow. Overused and abused tendons can be damaged or even destroyed. Performing the same repetitive motions over and over again can irritate and annoy the tendons, resulting in severe pain, tenderness, and even inability to use the affected extremity.Many treatments are available for latera...
Source: The Procedural Pause - August 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Back-to-Basics for Strains and Sprains: ACE Wraps, Aircast, and Velcro
​Simple ankle and wrist sprains and strains still need ACE wraps, Aircasts, Velcro wrist splints, or hard splints. Patients without fractures may still need assistive devices to help control their pain and place their injured extremity in a comfortable position while they heal. Hard splints (like Ortho-Glass) may be unnecessary. Appropriate splinting or hard casting, however, should be used to prevent further injury and decrease pain until follow-up. Strain, sprains, and even contusions do not need hard casting unless there is a high level of suspicion for missed injury, such as a Jones fracture, complicated avulsion inj...
Source: The Procedural Pause - July 3, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Back-to-Basics for Strains and Sprains: ACE Wraps, Aircast, and Velcro
​Simple ankle and wrist sprains and strains still need ACE wraps, Aircasts, Velcro wrist splints, or hard splints. Patients without fractures may still need assistive devices to help control their pain and place their injured extremity in a comfortable position while they heal. Hard splints (like Ortho-Glass) may be unnecessary. Appropriate splinting or hard casting, however, should be used to prevent further injury and decrease pain until follow-up. Strain, sprains, and even contusions do not need hard casting unless there is a high level of suspicion for missed injury, such as a Jones fracture, complicated avulsion inj...
Source: The Procedural Pause - July 3, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Back to Basics: Splinting
Check out this quick video by Martha Roberts, NP, and Carlynne DePolo, EMT, where they show you the basics of splinting in less than five minutes.​Future splinting segments will help you brush up on specialty splints and share pearls to make you a top performing clinician.Not only will splinting your own patient save you door-to-disposition time, it also guarantees to make your patient happy. Plus, you can position your patients just right, the way you want them to stay, until their follow-up. Read more about splint and cast methods and indications: http://bit.ly/2pWOzhc​.Watch Ms. Roberts and Ms. DePolo talk about spl...
Source: The Procedural Pause - June 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Back to Basics: Splinting
​We continue this month with our back-to-basics series on splinting. Check out this quick video by Martha Roberts, NP, and Carlynne DePolo, EMT, where they show you the basics of splinting in less than five minutes.​Future splinting segments will help you brush up on specialty splints and share pearls to make you a top preforming clinician.Not only will splinting your own patient save you door-to-disposition time, it also guarantees to make your patient happy. Plus, you can position your patients just right, the way you want them to stay, until their follow-up.Watch Ms. Roberts and Ms. DePolo talk about splinting basic...
Source: The Procedural Pause - May 3, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Nitty-Gritty of Splinting
​One of the most important things you can do as a clinician is to fix a patient’s immediate problem. Mastering certain procedures like splinting allows us to provide immediate solutions to patient problems when they arise. We all want to be masters when it comes to splinting, and here is why.EP splinting a complex distal radial fracture with the help of countertraction. stockinette, fiberglass splinting material, and ACE wrap are utilized.One of the more common mistakes NPs, PAs, and even MDs make is avoiding splinting their own patients. This means they spend less time at the bedside. If you personally splint your...
Source: The Procedural Pause - May 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Solution for Difficult Problems: Thumb Dislocation
​Finger dislocations in general are relatively simple to identify and treat, but ligament, tendon, or volar plate injuries are often missed. Thumb dislocations can present with or without lacerations, and are often associated with ligamentous injuries. An injured thumb is almost always treated with splinting. Follow-up for these injuries is crucial. Radiographs are useful in locating the areas of injury and identifying avulsion fractures.Thumb dislocation in a 24-year-old man 12 hours after injury.Listen to the patient's story to identify the mechanism by which the injury occurred because mimicking this mechanism is typi...
Source: The Procedural Pause - April 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Solution for Difficult Problems: Thumb Dislocation
​Finger dislocations in general are relatively simple to identify and treat, but ligament, tendon, or volar plate injuries are often missed. Thumb dislocations can present with or without lacerations, and are often associated with ligamentous injuries. An injured thumb is almost always treated with splinting. Follow-up for these injuries is crucial. Radiographs are useful in locating the areas of injury and identifying avulsion fractures.Thumb dislocation in a 24-year-old man 12 hours after injury.Listen to the patient's story to identify the mechanism by which the injury occurred because mimicking this mechanism is typi...
Source: The Procedural Pause - March 31, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

A Rare Intervention for an Unusual Exposure
​Children like to put things in their mouth, ears, nose, and eyes. A 9-year-old boy superglued his right eye shut and came to our pediatric emergency department. He thought the glue was an over-the-counter eye lubricant and filled his entire eye with the glue.​​Overdoses and poisonings are a dangerous threat to children. In fact, unintentional poison overdose or ingestion has continued to claim hundreds of children's lives. More than 300 children in the United States ages 0 to 19 are seen at EDs for poisoning and two of them die each day. (CDC. April 28, 2016; http://bit.ly/2kjVmhO.)Not all toxic exposures are in...
Source: The Procedural Pause - March 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

A Rare Intervention for an Unusual Exposure
​Children like to put things in their mouth, ears, nose, and eyes. A 9-year-old boy superglued his right eye shut and came to our pediatric emergency department. He thought the glue was an over-the-counter eye lubricant and filled his entire eye with the glue.​​Overdoses and poisonings are a dangerous threat to children. In fact, unintentional poison overdose or ingestion has continued to claim hundreds of children's lives. More than 300 children in the United States ages 0 to 19 are seen at EDs for poisoning and two of them die each year. (CDC. April 28, 2016; http://bit.ly/2kjVmhO.)Not all toxic exposures are inges...
Source: The Procedural Pause - March 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs