Small Joint Arthrocentesis Video
Michael Macias
Please enjoy our first Procedures Club FOAMed video for your viewing and learning pleasure. This week we discuss small joint arthrocentesis, specifically focusing on the wrist, the elbow, and the ankle. Straight from the mouth of our very own Dr. John Sarwark.
Tapping a small joint isn't too hard with a little help from our friends. Dr. John Sarwark from Procedures Club discusses proper technique in this awesome video with background music that will bring us back to the 1970s.
A priapism can potentially result in ischemia from sludging and clotting in the cavernosa. Irreversible impotence is another possibility. So yeah, it's an emergency, and uh, yeah, you've gotta drain it now.
Deliveries in the ED are obviously a rare event, and dystocias are a rarity inside of this rarity (representing about 0.6% to 1.4% of deliveries), but they still happen, and you need to know what to do if you end up with the catcher's mitt.
You might be thinking, "Transvenous pacing? Really? That made the cut?" We've chosen to highlight this procedure as it is, on paper, very straightforward, but in reality (as noted by several practitioners we've talked with), it can be filled with tons of confusing variables and details.
Fear not, dear reader, because you too can be like those grizzled colleagues of ours who point out that in their day, every IJ central line was done blind.
After our last post, a few viewers have suggested that we continue the trend of elevated compartment pressures and address a super duper rare yet potentially life saving procedure today. So, escharotomy....here-a we go!
Compartment syndrome can occur in any extremity, but the most common presentation you'll see is in the anterior compartment of the lower limb. It is an incredibly difficult diagnosis to make clinically, which is huge potential pitfall as correct identification can be delayed or even missed entirely.
Classically, patients will exhibit Beck’s Triad...Unfortunately, as we mentioned above only a minority of patients will exhibit all three. So the bottom line is that if you see someone who you think might be worth having their heart looked at, go ahead and slap an ultrasound probe on their chest.
You always have to remember that you cannot do a traditional cric on a child. Their cricothyroid membranes are just too small to accommodate an endotracheal tube, and you have an incredible high likelihood of damaging local structures.
Most providers I've talked to can count the number of cric's they've had in their career on one hand, but they remember every single, bloody detail of theirs, and will continue to do so until the day they die...
Enter the Sengstaken-Blakemore Tube, basically a last ditch effort for balloon tamponade. This procedure is not a common one given the prevalence and efficacy of endoscopy, but when you're all out of options it's either this or a body bag.
In the end it's not a terribly complex procedure, but there's something about cutting around the eyeball that is inherently unsettling.
EM Curious warmly welcomes two new authors, John Sarwark and Andrew Pirrotte from the Procedures Club blog! First up, the ED Thoracotomy!
Broken hip? There is a nerve block for that!