GENITOURINARY PEDIATRICS TRICKS OF THE TRADE
Trick of Trade: Dual Foley catheter to control massive epistaxis

Massive epistaxis is considered a medical emergency that requires immediate attention. Symptoms of massive epistaxis include sudden and heavy bleeding from the nose, difficulty breathing, dizziness, and a rapid heartbeat. If left untreated, it can lead to significant blood ...

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GENITOURINARY PEDIATRICS TRICKS OF THE TRADE
Trick of Trade: Removal of Entrapped Metal Zipper

A young boy is brought to the pediatric emergency screaming at the top of his lungs by his parents. His penile skin is trapped in the zipper of his jeans. On a busy shift, you want a simple way to handle zipper injuries that minimizes pain, doesn't require resource-intensiv...

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CRITICAL CARE/ RESUS GASTROINTESTINAL TRICKS OF THE TRADE
Trick of Trade: Inflating the Esophageal Balloon of a Blakemore/Minnesota Tube without a Manometer 

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. He looks really bad, stating that he has been vomiting blood. He is hypotensive. He then vomits a copious amount of blood ...

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RADIOLOGY TRICKS OF THE TRADE ULTRASOUND
Trick of the Trade: Gel-free ultrasound-guided peripheral IV technique

Ever finally step away from a busy resuscitation and someone stops you for peripheral IV access? You set up everything, have the patient positioned, and then notice there is no sterile ultrasound gel. No gel? No problem. The trick is to eliminate anything of poor acoustic i...

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CRITICAL CARE/ RESUS ENVIRONMENTAL TRICKS OF THE TRADE
Trick of the Trade: Chest tube rewarming with Foley tubing connector

You have a pulseless hypothermic patient requiring aggressive internal rewarming. ECMO is not available, and you’ve made the decision to initiate thoracic lavage. After placing your chest tubes, you step back triumphantly, but in short order, the nurse hands you large diame...

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OPHTHALMOLOGY TRICKS OF THE TRADE
Trick of the Trade: Antibiotic ointment for removal of artificial nail glue from eyelids

A bottle of nail glue and timolol eye drops (reproduced with permission from BMJ Publishing Group Ltd [1]) You are working a busy shift in your department’s fast track area and sign up for a patient with a complaint of “eye pain.” The patient is a fan of glue-on nails and m...

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ENT EXPERT PEER REVIEWED (CLINICAL) TRICKS OF THE TRADE
Trick of the Trade: Managing Epistaxis with Merocel Nasal Packing and an Angiocatheter

There are many ways to manage epistaxis. Once nasal clamping and cauterization fail, the next step is to consider using tranexamic acid (TXA) and performing nasal packing. Inflatable packing devices such as a Rhinorocket are painful to insert and do not conform well to the ...

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TRICKS OF THE TRADE
Trick of the Trade: Winging It with External Jugular Cannulation

Sankoff J, et al. WJEM (2008) Imagine yourself caring for a patient that needs urgent vascular access, but several attempts at peripheral intravenous (IV) cannulation have been unsuccessful. You aren’t quite at the point where emergent intraosseous or central venous access...

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TRICKS OF THE TRADE ULTRASOUND
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 gel bottle is nearly empty. No matter how many times you vigorously shake the bottle, it’s impossible to get the viscous gel o...

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CRITICAL CARE/ RESUS TRICKS OF THE TRADE VIDEO
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-intubation hypoxia, hypotension, and acidosis is often easier said than done. Worse yet, the intubation process itself, especiall...

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