Clean up those pesky hairs. Use a length of elastoplast to pick up the residue hairs after shaving/clipping for ECG, suturing, cannulation etc.
Bleeding tooth. If a patient presents with persistent bleeding post dental extraction (or knuckle extraction), get them to bite down on a moistened tea bag. The tannic acid in the tea will curb the bleeding.
If they present with a tooth that has been knocked out: First try to sit it back in the socket it came from. If that isn’t going to happen, put in in a urine jar filled with milk. And off to see a dentist ASAP.
Naso Gastric insertion. Patient getting distressed whilst you are passing a Naso-Gastric tube? Before passing the tube get the patient to snort some xylocaine gel (the sort that we use for catheterization). Warn the patient that this will taste horrid. Place a moderate gob on their tongue and ask them to swallow it. Then squirt a small amount (around 2 mls) into the nostril and ask them to sniff it up as if they had a runny nose. Now wait a couple of minutes before proceeding.
Unconscious patient. Not sure if your patient is unconscious, or just pretending? Gently open their eyes. Any resistance to eye opening is a tell.
Once open, the pretending patient may roll their eyes back up into his head until you can only see sclera (known as Bellâ€™s phenomenon) or move around in short well defined (geotropic) tracking movements.
With patients who have a true decreased level of consciousness, passive eyelid opening is easy and is followed by slow eyelid closure. Blinking also increases in pretending patients, but decreases in true coma.
The eyes of patients who are unconscious may have a neutral position or exhibit a roving gaze where the eyes slowly scan back and forth across the visual field.â€¨For more ways to tell if your patient is pretending check this out: how to tell if your patient is playing possum.
Pill cutter. Need to break a small tablet in half? There are plenty of pill cutters available, but if you cant find one just carefully place a 25 G needle down flat on a clean surface. Holding the tablet between thumb and first finger, press it down firmly across the needle for a clean break.
IV Fluids. Stay all over your IV infusions. Place a sticker on your IV flasks. Mark in large print:
- The time the fluids started.
- The sheet and flask number from the medication order sheet.
- Optional: the half way time.
- The time the flask is to run over.
- The time the fluids are due to complete.
- Underline the times. For example:
Sweaty skin. A small bottle of roll-on anti perspirant can be kept for use on diaphoretic (sweaty) patients. Simply roll on to the skin surface before applying ECG dots to ensure the dont fall off.â€¨Even better than this is Tinc Benz ( used to be a common antiseptic used before Betadine became popular). Clean the area, then apply a liberal coating of Tinc Benz with a gauze swab. Allow to dry for a moment, at which time it will become very tacky. Guaranteed to secure ECG dots, cannula dressings, and tapes to the most sweaty of patients.
Clean 12-lead ECG. Cant get a good ECG tracing due to muscle tremor? Lay the patient flat and ask them to sit on their hands, that is, place their hands palm up under their buttocks. Then ask them to relax.
Air in IV line. Stop air from running down the line of an IV that has â€˜run throughâ€™.
When spiking the bag with the IV set, first turn it upside-down. Then, squeeze the air out of the IV bag before flipping it up to prime the line.
Watch this video to see what I mean.
Lid stuck. Cant open a medication, or solution bottle? Carry a rubber band in your kit. Simply wrap the rubber band around the lid a few times. The extra traction on the rubber will usually give you enough torque to get it open.
Difficult veins. Cant find any veins to draw blood from? Instead of using a tourniquet, use a manual BP cuff. â€¨Attach the cuff around the upper arm. Let the arm hang low for a bit to engorge with blood. â€¨Pump the cuff up. â€¨Pull the plunger out of a 5ml syringe. Then â€˜foldâ€™ over the tubing from the BP cuff and push it into the syringe. This will kink the tubing off and stop the air leaking out of the cuff whist you are performing your veinipuncture. Using a BP cuff rather than a tourniquet will often result in a better show of veins1
Got a tip or trick to add to this list?
I would be very keen to hear it.
- actually, you should rely on your sense of touch far more than your sense of sight when searching for a good vein. [↩]