Among the least commonly utilized intubation techniques stands the humble digital intubation. The name says it all: the intubator uses their index and middle finger like a miller blade to locate (by palpation) and lift the epiglottis before gliding the ETT between the fingers into the trachea. More commonly utilized in pre-hospital and tactical situations, […]

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 fortifying layer to make the repair easier. Technique illustrated below: essentially suture through the steri-strip […]

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 certainly dislike the procedure (prior studies have suggested patients find NGT placement to be the MOST painful ED procedure, over […]

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 tendon sheath injection, requires slightly more skill and a slightly more painful injection. But lo, another (not new) […]

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 nausea within 10 minutes when compared to placebo. All with no known […]

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 there is a time and a place for everything, so knowing how to improve your chance of successfully […]

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 most ED physicians,  so consequently much research and discussion has offered ultrasound techniques of varying degrees of complexity for assessing volume status. Here’s a […]

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 technique of hip reduction. Pop that femoral head back into the acetabulum by popping your […]