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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

Ultrasound: Foreign Body Removal
Part 2 in a SeriesAre you ready for summer? That means more bare feet, flip-flops, and the potential for foreign bodies of the foot and toe. We will continue to highlight tools and tricks to help you master soft tissue foreign body removal in the emergency department. A refresher on the basics of ultrasound is available in our blog post from last month: http://emn.online/1UGtduz.Foreign bodies of the toe or foot are common presentations in emergency departments, and one way to determine the size and shape of retained superficial foreign bodies is to use ultrasound and the linear probe. This simple technique may hel...
Source: The Procedural Pause - April 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Should Fluoro be Your New Go-To?
Part Three in a Three-Part Series   This is the third and final part of our series on foreign bodies and fluoroscopy. Click here for part one and here for part two.   This month, we walk you through a step-by-step guide with bonus video footage to aid in your technique. This progressive procedure is absolutely significant to your practice, and we hope you all get a chance to try it.     The Approach n        Identification of foreign body on plain film or ultrasound n         Saphenous or posterior tibial nerve block n         Enlargement of the wound or entrance site using incision...
Source: The Procedural Pause - January 4, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Tap that Knee! Basics of Arthrocentesis
Part 2 of a Series   Our series on joint care has given you a basic overview on knee arthrocentesis. Typically, it is not necessary to have an orthopedic consultant come to the bedside in the emergency department to do this procedure. Arthrocentesis is a procedure you can do well and feel confident about your technique.   Take a moment to review our last blog post on knee pain before reading this post and watching the accompanying video. (http://bit.ly/1Q7dG4h.) As always, review the anatomy; it plays a key part in successful bedside technique. Ultrasound-guided arthrocentesis is always a favored approach.   Although em...
Source: The Procedural Pause - October 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Dabbling in Dentistry
Most people will experience dental pain or a dental complication at some point in their lives. Dental pain is an incredibly common complaint by people of all ages, especially those who lack dental insurance and suitable hygiene habits. Sometimes, though, poor dentition or injury is simply a result of bad luck. Patients often present to the ED hoping to find a dentist and an answer to their problems.   Your first thought? “I am not a dentist. What am I going to do?” You’re right to an extent. We are not dentists, and often feel we have little to offer patients for acute issues that require equipment we don’t have...
Source: The Procedural Pause - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Hugest of the Huge Hematomas
Welcome to our new series, “Guts and Gore.” That title should serve as a warning that some of the videos we will use as teaching tools may be controversial and not for weak stomachs. We hope, however, that part of why you became an emergency provider was to handle sticky situations like the ones we will present. People like us have the ability to ignore blood and copious discharge, and instead focus on saving and improving the lives of our patients. Rarely are you thanked for this ability, and we hope this series on guts and gore will improve your technique, even when the going gets tough.   The Approach n Proper iden...
Source: The Procedural Pause - June 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Foreign Body to the Face and Facial Laceration Repair
Part 1 in a Series Wound care and suture repair are two of the most frequently encountered issues in the emergency department. It is the midlevel provider’s job to be familiar with proper wound care and suturing techniques as well as quick and safe treatment of soft tissue skin injuries. You can use various suturing techniques and styles, but it is important to find a few that really work for you, often tailored to the area of injury. This month, we are focusing on lacerations and puncture wounds to the soft tissue of the face. Future posts will touch on other suturing skills, with some great tips from our plastic surge...
Source: The Procedural Pause - January 31, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Pediatric Nasal Foreign Bodies
Many of my pediatric patients with nasal foreign bodies present to the emergency department for chief complaints unrelated to the nose. The young man shown below, for example, presented several years ago for the evaluation of dog bite wounds to the face. I could see the telltale signs and symptoms of a chronic unilateral nasal drainage the minute I walked in the room. (Figure 1.) Figure 1. Nasal drainage is the telltale sign of a nasal foreign body.   I questioned the patient and his father, and they offered no history to confirm insertion of a nasal foreign body. Nevertheless, a wad of mummified Halloween candy wrapping...
Source: M2E Too! Mellick's Multimedia EduBlog - September 3, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Here, Fishy, Fishy
The skilled ED provider always takes proper precautions before attempting fish bone removal and preparing for patient discharge. And a sensible provider never sends an anxious patient down river without a thorough exam.   Fish bones are usually slightly waxy, bendable, and sharp. These tiny bones lodge themselves in the throat with a vengeance. Common nesting sites of fish bones include the base of the tongue, tonsils, posterior pharyngeal wall, aryepiglottic fold, or upper esophagus. Late complications of leftover fish bones in the throat may cause airway obstruction or rarely esophageal perforation. The patient is alway...
Source: The Procedural Pause - August 29, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Feel the Felon
Last time we discussed some ways to approach and manage the acute paronychia, but yet another unfortunate criminal robs our nail of its fine fettle: the nefarious felon. The felon’s early signs and symptoms may be subtle so don’t be fooled. This tender, fingerpad infection is not to be ignored. The enclosed fascial spaces of the fingertip pulp will be tender, and appear red and hot, which should mimic your aggressiveness and approach to stop it in its tracks. Figure out that felon, be tender, and forge ahead!   Some thoughts before proceeding. Your fingertip has thousands of nerves, and is very sensitive. Consider all...
Source: The Procedural Pause - May 29, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs