Suturing the Thin-Skinned

The thin, friable skin of elderly patients can present a special difficulty for laceration repair. If you find yourself pulling through the skin as you try tighten knots, applying steri-strips along the edge of the skin can serve as a forti…

When consulting your surgical colleagues about a potential small bowel obstruction, you may often be requested to place a nasogastric tube for bowel decompression regardless of how the patient appears clinically. Your patient will almost ce…

Although not a difficult procedure, the traditional approach to a digital nerve block involves two painful injections to the the digital nerves on either side of a finger, and may yield inconsistent results. An alternative, the flexor tendo…

Sometimes the right tool for the job is right in front of your nose. Turns out that 3 nasal inhalations of an isopropol alcohol packets (you know, those swabs you us to prep for a peripheral IV) yields a significant decrease in patient naus…

Of the three primary locations for central line placements, most EM residents seem to be least well-versed in the now rarely placed subclavian central line. The feared complication of pneumothorax steers many doctors to other locales. But t…

Tanking up the volume-depleted hypotensive patient requires a fine balance between under-resuscitation and the pulmonary edema of overdoing it. “Dynamic” measures of fluid responsiveness are technically complex and likely inaccessible to mo…

Can’t get that posterior hip location back into place? Don’t have enough collective muscle in the ED to just brute force the thing to where it belongs? Then leverage the power of simple mechanical advantage and utilize the Captain Morgan te…

  Many ER residents have found themselves justifying an admission of an acute or decompensated heart failure patient to a skeptical admitting resident. For better or worse, the skepticism is not without reason; an initial ED admission…

So how do you use that big fancy LUCAS machine? Pretty easy actually, but worth knowing before your arresting patient arrives. 1) Position the machine on the patient: Put the yellow back plate under the patient; this should be neatly center…

  Want to read an EKG like a 3rd year med student? Recognize ST elevations. Want to blow your attending away with your savant-like EKG mastery? Start learning all the myriad STEMI equivalents. For today: the de Winter’s T-wave. What is…