Blog

Applying the Pelvic Binder: Pearls and Pitfalls

Tl;dr: (1) Never rock the pelvis. Firmly squeeze and hold. (2) Consider quickly assessing for rectal or vaginal bleeding prior to binder application as this would suggest an open fx into the vag / rectal vault. It will be difficult to complete the exam once the binder is on. (3) The binder is applied overRead more

The Supraclavicular Subclavian

Traditionally, central line placement in the subclavian vein (SCV) involves a landmark-based approach in which the needle is guided under the clavicle. For the U/S lovers, there is an alternative approach to the subclavian in which the sono may be utilized: the supraclavicular subclavian. Anatomy: The goal is to cannulate the SCV just lateral toRead more

Oops…is that part important?

There you were, minding your own business when EMS brings you a sick-as-can-be patient, intubated in the field for who knows what. Someone gets overzealous with their trauma shears and cuts off the pilot balloon on the endotracheal tube. This happened to me twice in my PGY2 year. Obviously, this ETT will need to beRead more

Interscalene Nerve Block – Knockout That Upper Extremity

The Interscalene Block So, you want to provide local anesthesia to the patient with a broken clavicle or a dislocated shoulder. Maybe there’s a proximal / mid-humeral fracture or an injury over the deltoid. Whatever your needs may be, the interscalene block is an option for targeted anesthesia in the upper extremity to knock out partsRead more

Lower Extremity Nerve Block: The Posterior Tibial Nerve

Today’s lower extremity block is going to be the posterior tibial nerve. The sensory distribution should be helpful for things like foreign bodies that need to be taken out of the foot.     Anatomy – The largest of the five nerves at the level of the ankle, the posterior tibial nerve is posterior toRead more

Lower Extremity Nerve Block: The Sural Nerve

  The next three series in the SinaiEM pearls will be on nerve blocks of the foot. Today is going to cover the sural nerve block which should anesthetize the area depicted by the cross-hatched area in the figure.   As a terminal branch of the sciatic nerve, the sural nerve innervates the lateral portionRead more

Awake Intubation Topicalization

Compiled from a variety of sources from #FOAMed (specifically, NYSORA and the ACCRAC podcast) and inspired by morning report today with Taryn and Tina, here is a quick and dirty rundown for awake intubation. Firstly, we should be considering this method when the two Venn diagrams of “anatomically challenging” and “enthusiastically cooperative” overlap in theRead more

Eye on the Prize: Can You Perform a Lateral Canthotomy?

When a patient presents with orbital compartment syndrome, performing a lateral canthotomy and cantholysis can be vision-saving. You may only have 60-100 minutes until the patient experiences permanent visual sequelae. Are you ready?   Indications: Indications to perform lateral canthotomy may be remembered with the mnemonic DIP A CONE. They include decreased visual acuity, intraocularRead more

Are you raising the head of the bed for your intubations?

“The role of a clown and a physician are the same – it’s to elevate the possible and to relieve suffering.” -Patch Adams   Do you regularly raise the head of the bed when you intubate? Well, maybe you should!   A recent manuscript in the American Journal of Emergency Medicine (Turner et al. 2017)Read more

Hyperpronation for Nursemaid’s elbow reduction

“Childhood means simplicity. Look at the world with the child’s eye – it is very beautiful.” -Kailash Satyarthi   Nursemaid’s elbow is a radial head subluxation, typically caused by a “pulling” mechanism. It occurs most often in children six months to five years of age. The child will present with pain and will not useRead more