San Francisco High Risk EM San Francisco High Risk EM Emergency Procedure tricksEmergency Procedure tricks

By Dr Michelle Lin Assoc Prof San Francisco General Hospital

How to not miss scalp woundsHow to not miss scalp wounds

LED lightManual palpationIrrigate wound – cut out tray to fit

neck/head (like at hairdressers)

Modified Hair Modified Hair Apposition Technique Apposition Technique

(HAT) trick(HAT) trickUses opposing hair strands + adhesive

• One full 360o revolution twist of hair

• Apply adhesive at twisting point

• Repeat this along length of wound

• Do NOT over-twist the hair.

• Do NOT tie a knot.

• Good for less reliable patients

Retracting swollen eyelidRetracting swollen eyelid

Retracting swollen eyelidRetracting swollen eyelid

If eyelids too swollen?If eyelids too swollen?Use bent paperclip retractionUse bent paperclip retraction

How to secure avulsed toothHow to secure avulsed tooth

Tissue adhesive and nasal Tissue adhesive and nasal bridge from N95 resp maskbridge from N95 resp mask

Faster preg test than serum Faster preg test than serum HCGHCG

2-3 drops blood in urine pregnancy testWait full 5 minutesJust as sensitive as urineConsider serum testing only as clinically

indicated

V-technique for finding femoral veinV-technique for finding femoral vein(thumb at pubic tubercle, index at ASIS(thumb at pubic tubercle, index at ASIS

V= femoral vein siteV= femoral vein site

In obese pts get someone to In obese pts get someone to retract abdominal wall so don’t retract abdominal wall so don’t

approach too lowapproach too low

Difficulty with chest drain insertion? Use Difficulty with chest drain insertion? Use bougie like a styletbougie like a stylet

EJ lineEJ line

Mandible gets in the way?Bend jelco at proximal 1/3 to get shallow

angle to cannulate with

Guidewire problems during Guidewire problems during CVC insertion?CVC insertion?

Guidewire not feeding or stuck– Reaspirate for blood– Flatten needle angle– Twirl guidewire

Lost the guidewire sheath– Temporarily straighten the ‘j’ end by

straightening guidewire

Radial gutter splint for 2Radial gutter splint for 2ndnd MC # MC #Cut POP from snuffbox to fingertip then fold Cut POP from snuffbox to fingertip then fold

over 2nd fingerover 2nd finger

Sits at base of thumb

Folds over dorsal and volar aspect of 2nd finger

Distal radius # -use a reverse Distal radius # -use a reverse sugar tong splintsugar tong splint

Measure from knuckle to past the elbowCut at halfway fold almost all the way

throughThis will sit at the thumb web, and the ends

fold at the elbow

Traditional technique for Traditional technique for anterior hip dislocationsanterior hip dislocations

Captain Morgan technique for Captain Morgan technique for anterior hip dislocationsanterior hip dislocations

(see on YouTube)(see on YouTube)

Ring removalRing removal

Wrap string from distal finger to proximal (on top of ring)

Wait 5- 10 minutes then remove ringNo need for cuttingNow where to find string?

How to remove metallic FB?How to remove metallic FB?

Use a rare earth magnetEven from the cornea!

Rare earth magnetRare earth magnet

How to reduce a rectal How to reduce a rectal prolapse?prolapse?

Apply sugar over the prolapse. Apply sugar over the prolapse. Osmotically draws water out Osmotically draws water out

of the prolapseof the prolapse