US-Guided Femoral Nerve Block for Hip Fracture

In light of a recent patient in our ED with a femoral neck fracture…   Rather than dose and re-dose opioids, consider an US-guided femoral nerve block for safer, longer, and more effective analgesia [1-3].   Courtesy of Robert J. Strony DO, RDMS, RVT via EMdocs.net:    FN: femoral nerve, SFA: superficial femoral artery, DFA: […]

ED Trick/Tips: IV Extension Set for Drainage Abscess

As the Teaching Resident in the ED this month, I have been asked to assist with a range of aspiration procedures, from peritonsillar abscess to paracentesis to priapism. Here is a procedural complication witnessed particularly for smaller residents with smaller forearms: The strength required for these providers to pull back on the syringe hinders their ability to […]

Dental Fracture Classification and ED Management

Ellis Classification System Ellis I: extends through enamel (radiopaque) Ellis II: extends through dentin (less radiopaque; similar to bone) tender to touch/air visible yellow layer of dentin Ellis III: extends through pulp (radiolucent) tender to touch/air visible pink/red area at center of tooth  (EMedicine) ED Management Ellis I: smooth rough corners; no urgent care required; cosmetic follow-up Ellis II: cover […]

Procedure Skill: Drainage of Ischemic (Low-Flow) Priapism

Inspired by the procedural skills of Dr.’s Lazarciuc, Milliner, and Rajpal… In brief, step by-by-step: Sterile field Dorsal penile nerve block: 2 cc of Lidocaine w/o Epi injected close to penile base, from 2 and 10 o’clock aimed toward center of shaft. Insert 19-gauge needle at 2 (and if needed, 10) o’clock. Can also use butterfly connected to syringe. […]

Ultrasound Water Bath

After pulling in a spectacular toe-tapping sideline-hugging outstretched 30-yard bomb just milliseconds before a crushing hit by multiple defenders (a Pearl unto itself), one of our own right-handed residents came down the next day with redness, swelling, and pain to the dorsal aspect of his right hand’s third metacarpophalangeal joint. A heated discussion in the […]

Mass Casualty Medical Triage

In light of the horrific mass casualty attack in Orlando, here is a review of the medical triage system for mass casualty events. Thoughts and prayers to the victims, their families, and all those affected.   Triage is used to determine who is most urgently in need of transport to a hospital (i.e. chance of survival, would […]

Postpartum Hemorrhage Pearls

Here are some very-quick and easy-to-read pearls to remember for the dangerous immediate postpartum complication of postpartum hemorrhage.   Most common causes Uterine atony (by far) Trauma (i.e. lacerations, surgical incisions, uterine rupture) Coagulopathy (persistent heavy bleeding can lead to consumption of clotting factors) Management Uterine massage. Tamponade bleeding from uterine cavity. Two large-bore IV lines. Make […]

Criteria for Transfer to Burn Unit

Taken from the American Burn Association’s Burn Center Referral Criteria: Partial thickness burns >10% TBSA Burns involving face, hands, feet, genitalia, perineum, or major joints Third degree burns (whitish, charred or translucent, no pin prick sensation in burned area) Electrical burns including lightning injury Chemical burns Inhalation injury Pre-existing conditions that may complicate management, prolong recovery, […]

Emergency Management Pearls in a Drowning Incident

In light of this morning’s toilet-related malfunction and Noah’s Ark-like flooding of the PA Conference Room……here are a few quick-to-read pearls about the drowning patient.   Epidemiology Leading cause of death worldwide among boys 5 to 15 years of age Risk Factors male sex (yeah, we do dumb things) age < 14 alcohol use low income poor education rural lack […]

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