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Tricks of the Trade
Michelle Lin, MD
UCSF Academy Endowed Chair of EM Education
UCSF Professor of Emergency Medicine
Zuckerberg San Francisco General
M_Lin
Disclosures
On the front lines:
Speed and efficiency are paramount
Tricks of the Trade
Nausea
Anaphylaxis Peritonsillar
No incision?
Tungsten ring
No strings
attached
Is there a doc
on the plane?
Abscesses
made easy
The ring is
stuck on my
finger
Anaphylaxis
Urticaria and wheezes
Anaphylaxis
Urticaria and wheezes
Anaphylaxis
Urticaria and wheezes
Zlatan Coralic, PharmD (UCSF)
The Dirty Epi Drip
Both epinephrine
vials have 1 mg
Dirty Epi Drip
1 L saline bag now has
1 mcg/mL of epinephrine
Run wide open in 18-gauge IV:
20-30 mL/min
(20-30 mcg/min)
Note: Push-dose epi is
100 mcg over 5 minutes
(20 mcg/min)
Pierce ET, et al.
Anesth Analg. 2013
Mar;116(3):614-8.
Nausea
Is there ondansetron?
What’s it called in Lithuanian?!
Thanks to Mark Culver, PharmD BCPS
(Banner-UMC Phoenix)
Beadle KL, et al. Ann Emerg Med, 2016. PMID: 26679977
3 deep nasal
inhalations
Decreased nausea within 10 minutes
compared to saline placebo
Peritonsillar Abscess
Better Visualization of PTA
+
Better Visualization of PTA
Thanks to Dr. Hagop Afarian
(Fresno)
Better Visualization of PTA
Variation on trick: Glidescope
“Tried using the glidescope instead of an old fashion larygoscope.
Fabulous! The audience enjoyed the video feed.”
- Dr. Kathryn Egly
Aspirate the PTA Safely
Aspirate the PTA Safely
Trim sheath of spinal needle such that
1-2 cm of the needle is exposed
Increase Pressure With
Smaller Volume Syringe
Pascal’s Law
Increase Pressure With
Smaller Volume Syringe
Pascal’s Law
Am J Emerg Med 2012
(PMID: 21129885)
24%
EMLA cream
application
&
Spontaneous
abscess rupture
Removing a Tungsten Ring
Removing a Tungsten Ring
Removing a Tungsten Ring
Ring Removal
I don’t
have any
string!
Ring Removal
Use an
oxygen face
mask strap
Ring Removal
Creativity is just
connecting things.
- Steve Jobs
Think creatively.
Connect the seemingly
unconnected.
Share.

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Editor's Notes

  1. http://media4.s-nbcnews.com/j/msnbc/Components/Photo_StoryLevel/080413/080413-travelill-hmed-1p.grid-6x2.jpg
  2. The pressure exerted over one surface of an incompressible fluid is equal to the pressure exerted on another surface.