Trick of the trade July 2012 competition

Hi folks

Competition time again! Dr Rob Bryant inspired me by suggesting we run a competition on a Trick of the Trade and see who could send in the best clinical tip or Trick they had!

Rob is off to a running start by sharing his Emergency Drug Card with us here

But you cant let him win the competition AGAIN?!

Here is MY Trick of the Trade for all you Prehospital and Retrieval Clinicians out there! Recently my base got the GE Vscan portable ultrasound device for testing.

Its a great little device but due to a minimum depth of imaging of 6cm has real trouble imaging the lung/pleural interface, all so crucial for assessment of possible pneumothorax. To me pneumothorax assessment is one of the game changer benefits of portable USS technology in the aeromedical, prehospital and retrieval medicine field.

SO I came up with a solution/workaround to image the pleural interface better with the GE Vscan!

Firstly here is what normal pleural/lungs sliding looks like in the absence of pneumothorax

Now during a recent aeromedical retrieval I taught the flight nurse how to image the pleural/lung sliding using the GE Vscan and a 100ml Saline bag as a sonogram adjunct. Check out our improvised technique!

The 100 ml saline bag allows the probe distance to be optimal to the pleura. I tested with 500ml mannitol bags, 1000ml saline bags and the 100ml saline bag was the best!

SO POST YOUR BEST TRICK OF THE TRADE HERE OR EMAIL THEM TO ME

mlecong@gmail.com

Winner will be judged by myself, Amit and Andy and announced first week of August. Prize is a copy of my Prehospital Anaesthesia syllabus and limited edition RFDS mouse pad.

5 thoughts on “Trick of the trade July 2012 competition

  1. In the era of the ez-io this trick might be redundant. But I have worked in a few places without this tech.

    Picture this your In a remote community with a profoundly dehydrated patient. The only cannula you can get is a pathetic 24gauge. What you do is keep the tourniquet up on the side you placed the line, infuse your fluid of choice, wait for the proximal veins to distend and then place your 14 or 16 gauge line and then rehydrate the patient to your hearts content.

  2. Doug sent in this trick..pretty cool!
    Hi Minh,

    Here’s one I’ve been using for years.

    My trick, which I use on pretty much every intubation be it in the OT or the roadside, is the Inflatable IV fluid pressure bag thingy.

    Position, position, position.

    I get my patient in as good a position as I can. Tragus to sternum etc.

    I place a deflated IV fluid pressure bag behind their neck with the little bellows to the right as I look at them.

    I add just a little air to the bag so that the head moves in to the “sniffing the morning air” position we all know and love.

    Apply you choice of poison.

    Perform Epiglottoscopy/ Laryngoscopy and with Larygoscope in my left hand I can gently see what’s on view while I have my right hand on the little bellows/3way tap. Then by either adding or releasing air from the pressure bag I can alter this view and once it’s optimal I can hold it right where I want it.

    It’s dynamic, effortless and then it stops and stays where my view is just peachy!

    In “the field” I pop a 500ml bag of crystalloid in the pressure bag. The Poisons mentioned above are administered distal to the pressurized fluid. Thus I can have all my intubation medications delivered under pressure from my intubating position.

    I like all the control. I don’t ever seem to need BURP and all that.

    I’ve been doing that for a long time. I have seen a recent blog on the same sort of thing.

    It’s so obvious really, I’m sure a lot of people have come up with it spontaneously.

    We should do another video.

    And if the Larygo-spoon goes viral I want some small cut of the doubtless massive profits!

    I have also been known to fashion Suction-via-ETT devices for those contaminated and bloody bloody airways. We could have fun with that too.

    See you tomorrow.

    Doug

    Sent from my iThing

    1. Love the double setup to have pressure in the infusion set as well as positioning for the view. But I prefer using left hand for the layringoscope (as usual) and with my right hand adjusting the position holding the occiput (instead of your bag). When optimal view I give over to assistant to hold in same position. Can go into placement or even add standard bimanual laryngoscopy maneuver on the neck with right hand (second hand of assistant if necessary) and finally attempt to get tube in.
      Saline back under patient’s back or buttocks for pressure infusion if needed.

      Compared to Doug’s solution (even his is more elegant) this gives 3 dimensions to use in adjustment (adding right-left, forward-back) instead of just up and down…

  3. Lots of great tips and tricks here, will definitely try the pressure bag trick for my next intubation! I have tried the vscan-through-saline trick, but didn’t exactly get a view of the pleural sliding that I would dare trust in clinical practice. Can you elaborate a bit on which profile you use (cardiac? Abdominal? ObGyn?) and other tips for optimizing view?

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