Pediatric Nail Bed Laceration Basics – Part 5
When and where should you use prolene? What about nylon suture threads? We will end with the latest on antibiotic use in hand injuries.Pediatric nail bed laceration and finger laceration. Tissue adhesives can be used in place of absorbable sutures for minor injuries to the nail bed.Nylon vs. ProleneHow do we decide on which to use and where to use it? Prolene is a synthetic, monofilament, non-absorbable polypropylene thread. This material can be difficult to handle, and many practitioners avoid using it. Its fishing thread-like structure makes it stiff, and its knots tend to be loose, especially for larger threads.Nylon...
Source: The Procedural Pause - January 3, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Solutions for Difficult Problems: Part 4: Pediatric Nail Bed Laceration Basics
How do you go about choosing your suture thread? Absorbable sutures may include polyglycolic acid, chromic catgut, or glycerol-impregnated catgut. Non-absorbable sutures are typically made of silk, Prolene, or nylon. Suture materials may be synthetic or natural, and they can be mono- or multifilament. Sutures may also be braided, unbraided, or coated. Sizes of suture materials also vary greatly. A 3.0-sized thread is a lot bigger than a 6.0-sized thread, for example.Keep these key principles in mind: The time it takes for the thread to be absorbed is dependent on the tissue type and thickness, the size and type o...
Source: The Procedural Pause - December 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Solutions for Difficult Problems: Pediatric Nail Bed Laceration Basics – Part 3
Our pediatric patient population is special, small humans with distinctive needs, medication doses, and unexpected challenges. The more you use the simple approach to pediatric emergency department procedures, the more you will experience faster, smoother, and better results.You don't have to get fancy unless of course you have a Child Life Program in your department. The materials are simple and the skill is straightforward. Adding a sense of humor, learning the words to "Frozen," and laughing with your pediatric patient (whenever possible) will also help ease the tension.A 4-year-old with pediatric nail b...
Source: The Procedural Pause - November 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Solutions for Difficult Problems:Eye Irrigation — Morgan Lens No More! Part 2
We promised you short, sweet, and simple solutions, and we plan to deliver. Many of the tools we want you to use may have merely been forgotten. The steps to complete these simple solutions will require just a few minutes of brushing up on the basics while watching our how-to videos and reading our step-by-step blog posts.One of the lengthiest procedures in the emergency department can be eye irrigation. Some patients may need 5-15 liters of normal saline flush, which can take hours. Alkaline products need ample flushing and constant reevaluation with pH checks to avoid ocular burns. Patients can get frustrated and often t...
Source: The Procedural Pause - October 3, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Simple Solutions for Difficult Problems, Part 1
Sometimes the best solution is the simple one, and this series of handy tricks will help you master the most difficult problems. The majority of the procedures require old-school techniques with a new flare. Many of these might have been forgotten, but just a few minutes of brushing up on the basics while watching our how-to videos and reading our step-by-step blog will get you ready.How many times have you removed objects from someone's ear? If it's too many to count and you have been successful, then you don't have to reinvent the wheel. But if you are looking for a different way to remove objects such as earbuds, insect...
Source: The Procedural Pause - September 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Anorectal Procedures: Thrombosed Hemorrhoids
We are going to get up close and personal this month to talk about hemorrhoids. You should be familiar with these painful offenders because half to two-thirds of people between 45 and 65 will suffer from their cruelty. (Am Surg 2009;75[8]:635.) Patients may seek emergency department care if they experience bleeding or severe pain from hemorrhoids.Hemorrhoids are highly vascular structures that are round or oval in shape. They arise from the rectal and anal canal, and sometimes appear around the anus itself. It is important to note that hemorrhoids do not have arteries and veins but special blood vessels called sinusoid...
Source: The Procedural Pause - August 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Beside Ultrasound Vital to Early DVT Diagnosis: Part 5 in a Series
Ultrasound may seem intimidating at first, but it is not a procedure out of your reach. Those of you still feeling shy about it should just play with it to increase your comfort level. It's OK to be early for a shift or to stay late figuring out the machine. Try using ultrasound on patients who will allow it and scribes who don't say no. It can't hurt, and it will make you a better and more knowledgeable provider.We all know an "official" ultrasound is needed to confirm a suspected DVT, but what if you just need to know right away? Picture this: You are starting an overnight shift and are already 10 patients ...
Source: The Procedural Pause - July 2, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
FOOSH It Good
BY LOICE SWISHER, MDA young woman came in after a FOOSH injury complaining of difficulty moving a painful shoulder. The Y view was difficult to obtain, but the AP view is below. What three radiographic signs help make the diagnosis? The signs include:The light bulb sign is when the humeral head is rotated internally so it looks more like a lightbulb than a club.The rim sign where there is an increased distance (more than 6 mm) between the arc of the glenoid and the arc of the humeral head. The distance is much closer at the top of the glenoid than the bottom in this image.There is an angle in Moloney's arch. There...
Source: The Procedural Pause - June 22, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
