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Central Line Troubleshooting. Beyond the Basics.

By Jonathan Mishoe | critical care, Sinai Resus, Tips and Tricks | Comments are Closed | 9 April, 2019 | 0

Needle, wire, nick, dilate, catheter. Sounds simple right? However, simple doesn’t always mean easy. Placing a central line on a mannequin can be much easier than the 250lb ESRD patient with peripheral vascular disease and a MAP of 50. Below are ten tips to help assist with successful line placement:   1) Manipulate the syringeRead more

Put down that FOBT

By Jayram Pai | GI, news, Pearl of the Day, Tips and Tricks | Comments are Closed | 16 October, 2018 | 4

“The HgB has dropped, have you checked a guaic?” How many times have you checked a FOBT in your workup for anemia? Let’s take a look at what FOBT is supposed to be used for. FOBT is a visual stool assay in which heme in the stool reacts with reagent hydrogen peroxide to oxidize guaiac, leadingRead more

Painless Foley insertion

By Kathy Li | Pearl of the Day, Tips and Tricks | Comments are Closed | 26 March, 2018 | 0

A 57yo M presents with new onset urinary retention for 3 days. The triage nurse attempts to place a foley catheter but is unable to pass it. Bedside ultrasound confirms a distended bladder. The patient is now complaining of urethral discomfort and his urinary obstruction has still not been relieved. Ketorolac has minimally helped his pain,Read more

Troubleshooting PEG tubes

By Kathy Li | GI, Tips and Tricks | Comments are Closed | 15 March, 2018 | 0

A patient is sent from nursing home at 10pm for a non-functioning PEG tube. He has a prior history of stroke with L sided weakness and is now bedbound at baseline. He has stable vitals, no abdominal tenderness, and is otherwise well appearing. What do you do next? You could call GI to help, butRead more

Median and Ulnar Nerve Blocks

By Kathy Li | Pearl of the Day, Tips and Tricks | Comments are Closed | 13 March, 2018 | 0

Injuries to the hands are a frequent complaint in the emergency department. When the injury isn’t limited to a single digit, or involves larger areas of the hand such as a burn or deep laceration, a nerve block can be an effective option for general pain control as well as any procedures you may needRead more

Oops…is that part important?

By Colin Pesyna | airway, critical care, Pearl of the Day, procedures, Tips and Tricks, Trauma | Comments are Closed | 31 July, 2017 | 2

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

Improving left upper quadrant view

By sinaiem | Sinaiem.us, Tips and Tricks | Comments are Closed | 19 February, 2015 | 0

Many clinicians are challenged when evaluating patients for perisplenic fluid as part of the FAST or RUSH examination. Here are some common problems and how to fix them. Fix probe location Make sure you are holding the probe in a longitudinal view, probe marker towards the patient’s head. Place the probe just above the costal margin,Read more

Spray bottle woes

By sinaiem | Sinaiem.us, Tips and Tricks | Comments are Closed | 16 January, 2013 | 0

Here’s a quick trick:   When the Transeptic spray bottle won’t spray, it is often because the pump has become disconnected from the plastic tubing within the bottle. Instead of trying to fish it out with forceps, just turn the whole bottle upside-down. Disinfectant Spray Bottle Troubleshooting from Sinai EM Ultrasound on Vimeo. I hope this takesRead more

What the Heck 2

By sinaiem | cases, Sinaiem.us, Tips and Tricks | Comments are Closed | 2 January, 2013 | 0

This patient presented with diffuse abdominal pain, tachycardia, and peritonitis on physical examination. A FAST exam was performed to assess for free intraperitoneal fluid, and the following view of was obtained transversely in the pelvis. First, just look at the still image and make your best guess. Then press play: Did the large anechoic structureRead more

Ultrasound Zen

By sinaiem | Sinaiem.us, Tips and Tricks | Comments are Closed | 27 December, 2012 | 0

To image something which moves, you must remain still. To image something which is still, you must move. If you think on this long enough, the point is self-evident and requires no explanation. Or, just see some examples below. We are pretty well adapted to seeing three dimensions at a time. Thus when imaging aRead more

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