Study 1: This was a RCT comparing scar cosmesis between 5-0 polypropylene (PP) sutures and 5-0 fast absorbing plain gut (FG) during layered repair of linear cutaneous surgery wounds. The study design used a split-wound, within person design. Inclusion criteria included: >18 y/o, scheduled for cutaneous surgical procedure with predictive linear closure, and willingness to return for follow-up visits.

Critical Cases takes a jaunt over to Fast Track to take care of a 28 yo female with complaints of a swollen, painful finger!

A quick summary chart of sedation levels from Dr. Guo. This is important when considering procedural sedation in the emergency department - using a standard language helps to clarify our goals and the risks when planning sedations.

Finger lacerations/injuries are common in the Emergency Department and obtaining adequate analgesia for repair is important. Here we review the basics of digital nerve blocks as well as two common techniques.  

A 76 yo female with a history of Stage IV breast Ca with metastasis to the lung presents to the ED with acute shortness of breath 10 hours after an outpatient placement of a right sided PleurX chest tube for drainage of recurrent malignant effusion......

A 23 yo male with a hx of insulin dependent diabetes and recurrent admissions for DKA presents to the ED with complaints of diffuse body aches. He is acutely ill appearing, agitated, and combative with staff, demanding pain medication, entering other patients rooms, and screaming. Realizing that this patient is severely ill, you wonder how you will de-escalate or sedate this patient safely to enable life-saving care to be rendered.....

Pericardiocentesis is a rarely performed, but potentially life-saving procedure. Commerical models are prohibitively expensive, but students and residents (and critical care fellows) still need to learn the mechanics, ideally with an ultrasound compatibile model. This week's post gives a step by step guide towards making a cheap, easy to fabricate phantom based on this fantastic paper published in the Journal of Emergency Medicne 2012: https://www.ncbi.nlm.nih.gov/pubmed/21925818

Good analgesia is crucial in fracture reduction. This can be achieved many different ways, including regional anesthesia, systemic pain medications, or procedural sedation.  For certain fracture types, such as wrist fractures, a hematoma block is often used.  Here are basic instructions, tips and tricks for performing a hematoma block.

Shoulder reductions - you probably think you're pretty good at these. And you're probably right. But there's often more to learn, and a review of the basics many help tweak your approach or learn a new technique!

"Put in a chest tube."  Great.  But which type of tube?  Dr. Adorno's got you covered.