Keywords: Lidocaine, Foley, NG tube (PubMed Search)
NG Tubes and Foleys:
Dovetailing off Dr. Hayes Lidocaine pearl on Thursday I thought we could provide an additional pearl on how to decrease pain with the insertion of Foleys and NG tubes.
Most providers use regular surgilube and coat the tip of the NG tube and foley with it prior to inserting it. Unfortunately this tends to only lubricate the first several centimeters of the passage you are trying to transverse, making the rest of the way a little uncomfortable.
Using a Uroget of viscious lidocaine allows you to actually inject the lubricant into the nares or urethral meatus. This will provide better lubrication of the entire passage and also provide some anesthesia.
Even if you do not want to use lidocaine most foley kits come with a syringe full of surgilube that can be injected into the urethral meatus helping to lubricate the passage.
Keywords: paracentesis, ascites, analysis (PubMed Search)
Paracentesis Part II- Ascites Fluid Analysis:
See last weeks procedure pearl for some hints on doing a paracentesis..
Now that you have the fluid what should you send it for:
Now for the analysis:
** Corrected definition of SAAG as it was initially reversed. Thanks to Dr. McCurdy on his proof reading.
Keywords: Paracentesis (PubMed Search)
Since we have covered so many other procedures I though I would include paracentesis for completion.
A diagnostic paracentesis (typically 30-60 ml) is indicated to:
A therapeutic paracentesis (large volume >1L) is indicated in the emergency department for:
Remember large volume paracentesis can result in profound fluid shifts and subsequent hypotension.
Absolute Contraindications to paracentesis include: Acute abdomen requiring surgery
Relative contraindications are:
To view a video on how to do a paracentesis please visit the New England Journal of Medicine http://content.nejm.org/cgi/content/short/355/19/e21
Next I will address how to interpret the paracentesis fluid results.
Keywords: Dental Blocks (PubMed Search)
Dental Pain and Blocks:
I am sure that most of us have felt like we should have attended dental school when we see the fifth toothache of the day, but for those with true dental pain it can be severe and debilitating. For these patients the only way to truly get their paint under control is to perform a dental block. This will provide the patient with several hours of excellent pain relief, and may be all they need before seeing a dentist the next day.
For those that are not familiar with dental blocks, a great web page that I found that covers the advantages and disadvantages of the more common blocks is http://www.septodont.ca/Septodont/english/other/cea_di01.html
So for your next dental pain consider performing a dental block instead of just sending them home with a P&P pack (percocet and penicillin)
Keywords: Urinary Catheter, Foley, Coude (PubMed Search)
Placing a foley catheter in a patient with BPH or acute urinary retention can be very difficult at times. Here are some tips to increase your chance of a successful placement.
If all else fails, a suprapubic catheter may need to be placed. For a great review on evaluation and treatment please see Drs. Vilke, Ufberg, Harrigan, and Chan's article in the August edition of Journal of Emergnecy Medicine entitled Evaluation and treatment of acute urinary retention.
Vilke GM, Ufberg JW, Harrigan RA, Chan TC. Evaluation and treatment of acute urinary retention. J Emerg Med. 2008 Aug;35(2):193-8.
Keywords: Femoral Vein, Access, Cannulation (PubMed Search)
Most people are now using Ultrasound to aid in cannulation of the femoral and internal jugular veins, but if you find yourself without the ultrasound machine you can increase your chance of successful cannulation of the femoral vein by positioning the leg properly.
Werner et al looked at the common femoral veins of 25 healthy volunteers and noted that the femoral vein was accessable more often when the hip was abducted and external rotated. This simple position change increased the mean diameter of the vein, and prevented the vein from being directly posterior to the artery.
Werner SL, Jones RA, Emerman CL. Effect of hip abduction and external rotation on femoral vein exposure for possible cannulation. J Emerg Med. 2008 Jul;35(1):73-5.
Keywords: Meningitis, Lumbar Puncture, (PubMed Search)