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Tactical Medicine News

Trick of the Trade: Winging It with External Jugular Cannulation

by Mohamed Elhadi Abdelhameed, MD
Sep 09, 2022
Sankoff J, et al. WJEM (2008) Imagine yourself caring for a patient that needs urgent vascular access, but several attempts at peripheral intraven...
Tactical Medicine News

Trick of the Trade: Getting the last bit of ultrasound gel from the bottle

It’s a busy shift and you need to perform a bedside ultrasound on a patient’s belly to rule out cholecystitis, when you realize that the ultrasound...
Tactical Medicine News

Trick of the Trade: A “Fiberbougie” through a supraglottic airway device (King tube)

Resuscitation before intubation is a critical construct in modern emergency medicine. The prevention of peri-intubation arrest by correcting pre-in...
Tactical Medicine News

Trick of the Trade: Don’t fight the ultrasound cord for peripheral IV access

Ultrasound-guided IVs require hand-eye coordination and fine movements of probe in Goldilocks fashion. Apply too much pressure, and the vein in que...
Tactical Medicine News

Trick of the Trade: DIY Nasal Snot Aspirator

Nasal congestion is a common symptom of upper respiratory tract infections, such as bronchiolitis, in newborns and infants. Because newborns are ob...
Tactical Medicine News

Trick of Trade: Large-Bore Endotracheal Tube To Suction the Occluded Airway

The paramedics just arrived with a new patient to the resuscitation room. You find an altered patient actively vomiting bloody vomitus and food par...
Tactical Medicine News

Trick of the Trade: Persistent Paracentesis Leakage 2.0

You’re seeing a patient returning to the ED after a recent diagnostic paracentesis. The patient is complaining of persistent peritoneal fluid leaka...
Tactical Medicine News

Trick of the Trade: Upsize the IV with the tourniquet infusion technique

There you are, middle of the night and EMS just brought you one of the sickest of the sick: a septic-looking, chronically ill-appearing, frail, and...
Tactical Medicine News

Tricks of Trade: Benign paroxysmal positional vertigo | Beyond the Basics

Clinical Case A 63-year old female presents to your ED with positional dizziness since rising out of bed from a nap this afternoon. She says she ha...
Tactical Medicine News

Tricks of the Trade in Emergency Medicine book holiday sale

Well wishes to all of you for this COVID-19 holiday season. As a thank you for your public health efforts and sacrifices during this pandemic, we a...
Tactical Medicine News

Trick of the Trade: Windex for Ring Removal

A 41-year-old male presents with left-hand pain after an altercation. The patient’s hand is noted to be swollen and tender, particularly over the 4...
Tactical Medicine News

Trick of the Trade: Angiocatheter for manual aspiration of priapism

A 25-year-old man presents with 6 hours of penile pain and swelling after recreational penile injection of Trimix (alprostadil, papaverine, and ph...
Tactical Medicine News

Trick of the Trade: Sodium Bicarbonate for Acute Symptomatic Hyponatremia

A 25-year-old woman is brought into the emergency department by friends due to “acting weird.” She was at a rave and is reported to have consumed ...
Tactical Medicine News

Tricks of the Trade Book: Pre-order release of first 500 copies

Will there be a return to book publishing in this era of digital information chaos and overload? We believe so. We are proud to announce “Tricks of...
Tactical Medicine News

Trick of the Trade: An Improvised Foreign Body Removal Device

Foreign bodies in the ear or the nose can be extremely challenging to remove, especially considering that a majority of them occur in children less...
Tactical Medicine News

Trick of the Trade: Identifying Team Members in Protected Code Blues

Your team in the Emergency Department (ED) receives a call from your local Emergency Medical Services (EMS) crew informing you that they are transp...
Tactical Medicine News

Trick of the Trade: Face mask hacks

A 35-year-old male working as a healthcare worker presents for evaluation of ear discomfort. The skin behind his ears has been red and irritated si...
Tactical Medicine News

Trick of the Trade: Deflate an Undeflatable Gastrostomy Tube

A 54-year-old female with a past medical history of throat cancer presents for gastrostomy tube (G-tube) replacement. The initial G-tube was placed...
Tactical Medicine News

Trick of the Trade: Tracheostomy leak temporization

Patients who are tracheostomy and ventilator dependent are at increased risk for complications the longer they remain in this condition. One common...
Tactical Medicine News

Trick of the Trade: Directed Saline Irrigation for Nasal Suctioning

You are just starting out your mid-January evening shift, and you go to the room of an 8-month old male with nasal congestion. He is afebrile, and ...
Tactical Medicine News

Trick of Trade: Topical lidocaine jelly takes the tears out of skin tears and road rash

Skin tears are a common injury treated in the elderly in the emergency department (ED). Often the skin is paper thin, and the area involved can...
Tactical Medicine News

Trick of the Trade: Combine Adenosine with the Flush

2019 literature update from this original 2012 Trick of the Trade post! The success of adenosine depends as much on the administration technique...
Tactical Medicine News

Trick of the Trade: Save the Ultrasound Probe Cable

You need to perform an ultrasound on your patient. You walk up to the ultrasound and upon grabbing the machine, you notice it’s stuck! You look...
Tactical Medicine News

Trick: Peritonsillar abscess drainage 3.0 | All the steps with added variations

A 25-year-old medical student comes in with a muffled voice, sore throat and trismus. You look at the back of her throat and you see the uvul...
Tactical Medicine News

Trick of Trade: Topical lidocaine jelly to make constipation relief less painful

Severe constipation, requiring fecal disimpaction and rectal enemas, can be excruciatingly painful for patients. Administering sedatives and ...
Tactical Medicine News

Trick of the Trade: Bubble Study for Confirmation of Central Line Placement

The safe placement a central venous catheter (CVC) remains an important part of caring for critically ill patients.1 Over 5 million CVCs are pl...
Tactical Medicine News

Trick of the Trade: Hair tourniquet removal using depilatory cream

A hair tourniquet occurs when a strand of hair coils around a patient’s appendage. It can cause damage to the skin, nerves, or affect blood supply...
Tactical Medicine News

Trick of the Trade: DIY Skyhook for Upper Extremity Swelling

A 25 year-old male presents to the ED complaining of left upper extremity pain, redness, and swelling. His cat bit him 2 days ago and his symptoms ...
Tactical Medicine News

Trick of the Trade: Fishhook Removal Techniques

Penetrating fishhook injuries can be a common occurrence during the warm weather months. Initially, it is important to evaluate what type of fishho...
Tactical Medicine News

Trick of the Trade: Topical Treatment of Cannabinoid Hyperemesis Syndrome

A 23-year-old female with no past medical history presents to the ED for the 4th time this month complaining of severe “10-out-of-10” abdominal pai...
Tactical Medicine News

Pediatric Trick of the Trade: Finger Immobilization Technique

A 3 year-old boy presents with a deep laceration of the distal phalanx, through the nail bed, after slamming his fingers in a car door. He is cryin...
Tactical Medicine News

Trick of the Trade: DIY Squirt Bottle Wound Irrigation

Wound irrigation is arguably one of the most important steps in closing a laceration, because all lacerations should be considered to be contaminat...
Tactical Medicine News

Trick of the Trade: Gaze Testing Using “Selfie Mode” on Your Smartphone Camera

The NIH Stroke Scale is used to assess the severity of a suspected stroke. It includes 11 neurologic exam components that can be quickly performed ...
Tactical Medicine News

Trick: Linear Ultrasound Transducers in Intrauterine Pregnancy Evaluation

The volume of women presenting to the emergency department (ED) with newly diagnosed first-trimester pregnancies and suspected ectopic pregnancies ...
Tactical Medicine News

Trick of the Trade: Sphenopalatine Ganglion Block for Treatment of Primary Headaches

It is thought that the autonomic nervous system is likely involved in migraines and other primary headache disorders given commonly associated symp...
Tactical Medicine News

Trick of the Trade: Rapid Insertion of Orogastric Tube

We have all been in the situation: an intubated patient needs an orogastric (OG) tube and no one has been able to place it successfully. Unfortunat...
Tactical Medicine News

PEM Pearls: Calming techniques while repairing a laceration

Most children who come into the Emergency Department present with pain or experience pain during their ED stay.1,2,3 Pain and distress during a pro...
Tactical Medicine News

Trick of the Trade: Warfarin tablet strength identification

Medical providers commonly encounter patients in the emergency department who state they are anticoagulated with warfarin, but they have no idea wh...
Tactical Medicine News

Trick of the Trade: A cleaner way to apply dental cement for a tooth fracture

The management of a dental fracture is a core skill of the emergency physician.1 When the enamel is violated and the underlying dentin is exposed (...
Tactical Medicine News

Trick of the Trade: Simple finger traps using gauze roll

Closed reduction of fractures or dislocations in the hand and wrist can be difficulty to achieve. Gravity can serve as an assistant. Commercial fin...
Tactical Medicine News

Trick of the Trade: Paraphimosis – Pour Some Sugar On Me

Paraphimosis occurs when a retracted foreskin can’t be reduced back over the glans of the penis. Risk factors for paraphimosis include scarring, vi...
Tactical Medicine News

Trick of the Trade: Ear Irrigation in the Emergency Department

Ear irrigation is an important tool for adult and pediatric patients in the Emergency Department (ED) with ENT complaints. Irrigation can be used t...
Tactical Medicine News

Trick of the Trade: Ocular ultrasound for the swollen traumatic eye

You are caring for a patient with an incredibly swollen eye – like a scene out of almost any Rocky film. This patient is likely going to the ...
Tactical Medicine News

Trick of the Trade: Tibial Intraosseous Line Stabilization in an Agitated Patient

With the advent of commercial intraosseous (IO) needles for vascular access, administering IV medications for patients in extremis has been made mu...
Tactical Medicine News

Trick of the Trade: Pre-Charge the Defibrillator

In cardiac arrest care it is well accepted that time to defibrillation is closely correlated with survival and outcome.1 There has also been a lot ...
Tactical Medicine News

Trick of the Trade: Ultrasound for Pedal Pulse Identification and ABI

The Problem: A patient is rolled in to your ED by EMS with extremity trauma. You’re rightfully concerned about possible vascular injury to an upper...
Tactical Medicine News

Trick of the Trade: Securing the intraosseous needle

So much attention is appropriately focused on the anatomy and technique for intraosseous needle placement. In contrast, very little attention is pa...
Tactical Medicine News

Trick of Trade: Build-it-yourself IV Fluid and Drug Administration Trainer

Simulation equipment can be rather expensive and wanting to practice fluid and drug administration does not always warrant the purchase of speciali...
Tactical Medicine News

Trick of the Trade: Topical Tranexamic Acid Paste for Hemostasis

Tranexamic acid (TXA) can be used in a wide variety of settings in the Emergency Department for its hemostatic effects. Topical applications of TXA...
Tactical Medicine News

Trick of the Trade: Extra-oral reduction technique of anterior mandible dislocation

Anterior dislocation of the mandible is a clinical scenario that is not infrequently encountered by the ED provider and requires prompt inter...
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