Moderator EMEDPA Posted October 31, 2009 Author Moderator Share Posted October 31, 2009 EMEDPA: All the tips you give are identical to my EM instructors. You don't happen to teach in AZ do you? :) nope...but there's a chance I trained your preceptors... 1 Quote Link to comment Share on other sites More sharing options...
welkins Posted November 22, 2009 Share Posted November 22, 2009 Anybody use an umbilical tape or heavy string to remove a fish hook. I havent had to push thru and cut off a hook since I started using umbilical tape. Quote Link to comment Share on other sites More sharing options...
DHarrill Posted February 7, 2010 Share Posted February 7, 2010 Can you elaborate on the umbilical tape method? I'm not familiar with this one. Quote Link to comment Share on other sites More sharing options...
welkins Posted February 10, 2010 Share Posted February 10, 2010 I cleanse and localize the area where the hook is located. Next tie about 2 ft of umbilical tape around the hook with a half-hitch and slide it down near the skin where the barb is embedded. Push the eye of the hook down to the skin and it will disengage the barb from the undersurface of the dermis. Give a quick short jerk on the umbilical tape and the hook will pop right out still tied to the tape. The wound can then be irrigated and dressed. I have done this hundreds of times with no problems or complaints. I even carry stuff in my tackle box in case I get one in myself when I am fishing. Quote Link to comment Share on other sites More sharing options...
ezetimibe Posted April 20, 2010 Share Posted April 20, 2010 In my experience the occlude nostril/ blow in mouth works about 50% of the time. Trick is you have to ask grandma to do it. Never works with mom. Quote Link to comment Share on other sites More sharing options...
Evolute Posted May 29, 2010 Share Posted May 29, 2010 I don't use the rhino rocket I use the rapid rhinohttp://www.arthrocareent.com/wt/page/rapidrhino I've had great sucess with the rhino rocket as well. Only had one fail, and that's because the guy looked at me and said. " yeah, this sh$t aint goona f@#kin' work"!! And promptly pulled it out. balloon inflated!! Quote Link to comment Share on other sites More sharing options...
ezetimibe Posted December 15, 2010 Share Posted December 15, 2010 Another tip, use Afrin spray before the occulde and blow method. Also ask grandma or any willing family member to blow through the childs mouth. Use a paper towel to block that person's face to avoid the hailstorm of snot that will ensue. Quote Link to comment Share on other sites More sharing options...
Emerson Posted January 25, 2011 Share Posted January 25, 2011 DERMABOND The applicator tip often poses problems with accuracy when trying to repair a wound. So, I developed a method that really has improved my technique: 1) Use the RhinoPinch Nasal Clip (epistaxis) to bring the wound margins together and keep the margins in place for repair 2) Break the ampule and insert a 22 gauge needle / syringe and draw up the Dermabond 3) Apply the Dermabond in a controlled fashion, layer by layer 4) Steri Strips and you're done Quote Link to comment Share on other sites More sharing options...
cobramarty Posted January 25, 2011 Share Posted January 25, 2011 Roach in the Ear. You must kill the roach first. ONLY use mineral oil. Fill the canal with mineral oil and wait 5 minutes and then use forceps to grab the critter and pull it out usually whole. Never use water, lidocaine, peroxide or anything else as they will only piss off the roach and really upset the patient. Alligator/spider grabber device always breaks the roach up and you end up taking out pieces- leg by leg. Punch biopsy always for tick bite and nail thru the shoe into sole of foot. Love the blow into the mouth for nasal FB. I get parent to do it, I laugh inside a little to see the bead and snot pop out and hit them in the cheek. Sort of a negative reinforcement to keep small things away from their children. Merocel is my preference but usually have to use what is stock and on hand. Small scalp lacs on kids- Pull a few strands of hair on either side together to close the wound and twist the hair and 'seal/tie' the 'knot' with dermabond. No needles. Parents and kids will love you. Quote Link to comment Share on other sites More sharing options...
Just Steve Posted January 25, 2011 Share Posted January 25, 2011 (edited) While not a PA yet, I do get into some tough situations on occasion as a paramedic. My current nemesis is emesis. Many years ago I had a 12 year old collapse due to acute allergic reaction. Of course it was on a full stomach and after BLS BVM'd for awhile, it made for what i described as a Mt. Vesuvius of vomit that was unstoppable. Portable and later wall suction was woefully inadequate. The eventual outcome was far less than desirable. Years later (> 10) I ran into the same situation with an adult and despite a ton more airway management experience, we went down the decision tree to cric, by the time we got their, their airway was filled with emesis, which flowed up the Quick Trach. At least this time the patient was already in cardiac arrest with an unknown downtime so it made sleeping at night a little easier. I have been part of discussions that involve the concept of placing a smaller cuffed ET blind, inflating the balloon. The theory is if you are in the esophagus, the emesis will flow up the tube and you can direct it away, then place a second tube, the only place left open will be the trachea. If the first tube some how goes into the trachea, then you're golden off the bat. I have yet to find anyone who has actually performed this technique. Anyone out there? Second issue I fear is a hemorrhagic lung such as a penetrating injury to the chest. Again, I have been part of discussion of placing an ET down the Right bronchus in the case of left lung injury, thus taking the left side lung out of the ventilation equation. In the case of right lung injury, I have heard of placing a right main stem tube, then passing a Foley through the ET, inflating it, sealing off the Right main stem, then withdrawing the ET, placing a new ET into the main bronchus to ventilate the left side. Trouble is, the fill port on the foley will not allow the ET to be fully withdrawn. You can't cut the inflation valve off the foley because that will deflate the balloon...how would one get around this issue? Trim the ET tube? Sorry for the long winded post... Steve Edited January 25, 2011 by Just Steve spelling Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted January 26, 2011 Share Posted January 26, 2011 Vomit management: most patients can vomit much faster than you can suction. Roll pt. on side (preferably away from you) until heaving done. Sweep or suction mouth until mostly clear. Then, suction as needed. Works best when patient is strapped to long back board. Restraint of combative patients: 1) ALWAYS restrain to long back board, not cot or bed. This makes it possible to move patient from one place to another without undoing & redoing restraints. It also makes it possible to role patient on side if they vomit - see above. 2) Restrain 1 arm above shoulder, above head, & to high side of backboard above opposite shoulder. 3) Restrain other arm diagonally across torso to backboard waist high on opposite side. 2 & 3 effectively prevent patient from raising head & chest off back board. 4) Restrain legs by restraints on ankles to opposite lower end of board - crossing legs. This eliminates kicking. 5) Place backboard strap across thighs just above knees. This prevents bending legs and pushing up. With 1 person per extremity and 1 more to get back board in place, smaller staff can handle much larger patients safely. Quote Link to comment Share on other sites More sharing options...
janede Posted January 31, 2012 Share Posted January 31, 2012 FB removal:First I swab with our TLE (top lido epi) gel...numbs,shrinks and controls bleeding) but I found out by luck: some of the forceps from the OR are magnetized!!!: had 5yo girl who had sm magnets in her nose stuck to each other through the septum (these are from earrings that little girls use to simulate pierced ears) As I reached for the magnet, the first one jumped to the forceps and 2nd fell out. Id guess some other metal objects are magnetized as well. Re ears: first order: RN to irrigate (after auragulan) at least 75% time, its out, everyones happy no sharp things used. Quote Link to comment Share on other sites More sharing options...
janede Posted January 31, 2012 Share Posted January 31, 2012 FB removal:First I swab with our TLE (top lido epi) gel...numbs,shrinks and controls bleeding) but I found out by luck: some of the forceps from the OR are magnetized!!!: had 5yo girl who had sm magnets in her nose stuck to each other through the septum (these are from earrings that little girls use to simulate pierced ears) As I reached for the magnet, the first one jumped to the forceps and 2nd fell out. Id guess some other metal objects are magnetized as well. Re ears: first order: RN to irrigate (after auragulan) at least 75% time, its out, everyones happy no sharp things used. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 31, 2012 Author Moderator Share Posted July 31, 2012 time to revive this thread. heard a great pearl from an intensivist at my rural em job this weekend: don't think of a lactate level as a screen for sepsis, think of it as a tool for adding to the ddx of hypotension in those pts in which a cause is not immediately obvious. lots of folks who are septic are not obviously septic on presentation and have nl or low temps. just something to think about. 1 Quote Link to comment Share on other sites More sharing options...
jen0508 Posted July 31, 2012 Share Posted July 31, 2012 this isn't really EM specific but heres a tip i recently learned for doing a pelvic on obese women and women with prolapse (ya know, when the "walls" are closing in between the blades obscuring your view of the cervix and being painful for the patient). take a latex glove and insert the speculum through one of the fingers of the glove, rip the end off. this way you can still see through the end of the speculum to search for the cervix but there is a barrier (the glove) between the blades to keep the walls from closing in. 1 Quote Link to comment Share on other sites More sharing options...
Guest Paula Posted July 31, 2012 Share Posted July 31, 2012 this isn't really EM specific but heres a tip i recently learned for doing a pelvic on obese women and women with prolapse (ya know, when the "walls" are closing in between the blades obscuring your view of the cervix and being painful for the patient). take a latex glove and insert the speculum through one of the fingers of the glove, rip the end off. this way you can still see through the end of the speculum to search for the cervix but there is a barrier (the glove) between the blades to keep the walls from closing in. I've tried that and it did not work very well. Maybe it's because we don't use latex gloves, or the walls of fat are just too much for the glove. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 31, 2012 Author Moderator Share Posted July 31, 2012 I typically use one-two female assistants to retract the extra tissue out of the way. Quote Link to comment Share on other sites More sharing options...
MediMike Posted August 1, 2012 Share Posted August 1, 2012 I have been part of discussions that involve the concept of placing a smaller cuffed ET blind, inflating the balloon. The theory is if you are in the esophagus, the emesis will flow up the tube and you can direct it away, then place a second tube, the only place left open will be the trachea. If the first tube some how goes into the trachea, then you're golden off the bat. I have yet to find anyone who has actually performed this technique. Anyone out there? Steve I personally haven't used this technique, but have seen it done with success. The biggest issue I find with it is the time taken between placement of the initial tube and the second can be greater than you realize. Of course if you need an airway, it's better to have one in a slightly more hypoxic patient than none. Can always just look for the bubbles in the emesis too haha Quote Link to comment Share on other sites More sharing options...
Guest Paula Posted August 1, 2012 Share Posted August 1, 2012 I typically use one-two female assistants to retract the extra tissue out of the way. Ahh...many hands make light work! Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted August 2, 2012 Moderator Share Posted August 2, 2012 different topic don't work to hard on getting FB out of ears - just refer to ENT - I spent to much time the other month trying to get some tin foil out - should have just left it alone and sent to ENT Quote Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted August 2, 2012 Moderator Share Posted August 2, 2012 different topic don't work to hard on getting FB out of ears - just refer to ENT - I spent to much time the other month trying to get some tin foil out - should have just left it alone and sent to ENT A. Men. Speaking of FB's....neat new trick I tried the other day with nasal FB's (best done with a cooperative parent, and the FB is spherical)- pinch the opposite nostril closed, and have parent blow into mouth. FB should pop right out Quote Link to comment Share on other sites More sharing options...
Joelseff Posted August 2, 2012 Share Posted August 2, 2012 A. Men. Speaking of FB's....neat new trick I tried the other day with nasal FB's (best done with a cooperative parent, and the FB is spherical)- pinch the opposite nostril closed, and have parent blow into mouth. FB should pop right out "mother's kiss" heard/learned about this in PA school but never saw it done.... Sent from my myTouch_4G_Slide using Tapatalk Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 2, 2012 Author Moderator Share Posted August 2, 2012 A. Men. Speaking of FB's....neat new trick I tried the other day with nasal FB's (best done with a cooperative parent, and the FB is spherical)- pinch the opposite nostril closed, and have parent blow into mouth. FB should pop right out People swear by this. I have tried it several times and it has never worked for me. Quote Link to comment Share on other sites More sharing options...
ajnelson Posted August 3, 2012 Share Posted August 3, 2012 People swear by this. I have tried it several times and it has never worked for me. It works best for me for small things, like beads. If it is a larger object or paper, it has not worked well for me. Oh, and the parent usually needs to blow a heck of a lot harder than they think they need to! Quote Link to comment Share on other sites More sharing options...
MediMike Posted August 3, 2012 Share Posted August 3, 2012 Roach in the Ear.You must kill the roach first. ONLY use mineral oil. Fill the canal with mineral oil and wait 5 minutes and then use forceps to grab the critter and pull it out usually whole. Never use water, lidocaine, peroxide or anything else as they will only piss off the roach and really upset the patient. Alligator/spider grabber device always breaks the roach up and you end up taking out pieces- leg by leg. I've got to ask, I'm up in the PNW...Does this really occur that often? Quote Link to comment Share on other sites More sharing options...
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