MacGyver Medicine

[Daiphon]

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Interesting thread on chest tubes got me thinking about something:

We in EM live in a world of making things work... and repurposing equipment when necessary.

For example, peds uncuffed + mini stylet at ~90 degrees makes for an excellent lung sweeper (in my N=me experience).

What other RDA (Richard Dean Anderson) maneuvers do people have/use?

This should be interesting...

Cheers!
-d

Sent from my DROID BIONIC using Tapatalk

 

[GeneralVeers]

Two tongue depressors taped together at one end make an excellent nose clip for county ERs without the little plastic ones.

 

[Tiger26]

You can make a finger tourniquet for sewing up lacs by cutting a gloved finger and rolling it up over the patient's finger.

In addition, you can dunk the finger in a cup of lido with epi for a while to control bleeding.

 

[deleted6669]

no suprapubic cath kit?
no problem. a 14 g angiocath, some duct tape and a foley set up can fix that problem( done in Haiti for a uroseptic guy with a prostate as big as a tennis ball).

 

[Birdstrike]

.

 

[TysonCook]

You can make a finger tourniquet for sewing up lacs by cutting a gloved finger and rolling it up over the patient's finger.
.

....please note that this creates a much higher pressure than is needed, has been shown to cause NV injury, and is recommended against in several articles 🙂
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099617/

 

[deleted6669]

....please note that this creates a much higher pressure than is needed, has been shown to cause NV injury, and is recommended against in several articles 🙂
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099617/

yup, I just use a sm. penrose.

 

[EM_Rebuilder]

I use a whole glove and the curved clamps in our suture kit. I can stretch a finger of the glove around the base of the finger and adjust the tightness to just achieve hemostasis...

 

[turkeyjerky]

yup, I just use a sm. penrose.

The cited article actually shows the penrose to be the worst option.

 

[docB]

If you don't have a jet insufflator can you still do a needle cric and insuflate? Sure. But how do you mate the BVM to the Leur tip of the angiocath? You can either use a 3.5 mm pedi ETT plastic cap (it fits inside the leur tip) or you can use an adult ETT stuck inside a 10 cc syringe with the plunger removed and the balloon up. Either of those will get you though a few minutes while you regroup and work on a definitive airway.

 

[monkeybutt]

The other night I had a difficult intubation for a very anterior airway. I went to the glidescope, but couldn't pass my tube around it. I put a bougie in, but the curved part of the bougie was too crooked and was getting stuck above the cords. I turned the bougie around and used the straight end.

 

[pinipig523]

The other night I had a difficult intubation for a very anterior airway. I went to the glidescope, but couldn't pass my tube around it. I put a bougie in, but the curved part of the bougie was too crooked and was getting stuck above the cords. I turned the bougie around and used the straight end.

Did you try pulling out the glidescope stylet just about 2-5 cm out and advancing the tube?

 

[WilcoWorld]

Running a bag of NS hooked to nasal canula with the nasal ports placed above the bridge of the nose makes for great eye irrigation.

 

[monkeybutt]

Did you try pulling out the glidescope stylet just about 2-5 cm out and advancing the tube?

No, but that might have helped. I'll try that next time.

 

[pinipig523]

Other tips I have:

1. Take the bougie and bend the bent tip additionally so it makes a "J" with a bent tip. This is AWESOME for those anterior airways. Have your assistant keep it bent because these elastic bougies retract back to neutral position within 30 seconds.

2. I had a patient come in with a pleurex catheter but she lost the adaptor and she had a massive pleural effusion. There was no way to drain the catheter because of the lack of an adaptor. So I took an arrow kit and slipped the angiocath around the valve and it drained that way.

 

[DeadCactus]

Other tips I have:

1. Take the bougie and bend the bent tip additionally so it makes a "J" with a bent tip. This is AWESOME for those anterior airways. Have your assistant keep it bent because these elastic bougies retract back to neutral position within 30 seconds.

I think I remember hearing on EMcrit or ERcast that you could use ice water to chill the bougie to have to hold it's shape longer but I could be mixing things up...

 

[pinipig523]

I think I remember hearing on EMcrit or ERcast that you could use ice water to chill the bougie to have to hold it's shape longer but I could be mixing things up...

If you have that long to prep for a crash intubation... that's crazy. 🙂

 

[deleted109597]

I think I remember hearing on EMcrit or ERcast that you could use ice water to chill the bougie to have to hold it's shape longer but I could be mixing things up...

They recommended it for NG placement once. Forming it with a oral airway in an ice bath.

 

[EM_Rebuilder]

A standard ET Stylet, with a piece of oxygen tubing shoved over one end works well as a bougie.

Not all the stylets work thought... found that out once moonlighting. It has to be the thicker ones with a rubber coating over them. I carried one with me moonlighting 'just in case'. We used them in residency occasionally as sometimes we would be out of bougies...

 

[SoCuteMD]

A standard ET Stylet, with a piece of oxygen tubing shoved over one end works well as a bougie.

Not all the stylets work thought... found that out once moonlighting. It has to be the thicker ones with a rubber coating over them. I carried one with me moonlighting 'just in case'. We used them in residency occasionally as sometimes we would be out of bougies...

Why the oxygen tubing?

 

[DeadCactus]

They recommended it for NG placement once. Forming it with a oral airway in an ice bath.

Ah, that's right. Thank you.

 

[pinipig523]

Why the oxygen tubing?

So you have length and you can protect the cords from the rather unforgiving stylet.