@precordialthump I totally forgot about the EKG library! Awesome stuff. Keep up the great work (when do you sleep?!)
258 days ago
@emeducation Perfect, thanks for the suggestions! Turns out one is co-authored by Jeff Tabas. He already gave them all books.
258 days ago
Recommendations for an EKG resource to review bread & butter cases for senior residents? Pre-graduation panic setting in for our residents.
258 days ago
@danipedia Good point. I use the studies to convince the trauma consults NOT to get c-spine imaging on EVERYONE (citing distracting injury)!
263 days ago
@doctorflash Hi there. Just wanted to drop a note to thank you for all the extra traffic you're sending to blog. Much appreciated!!
273 days ago
Tricks of the trade: Anesthetizing the nasopharyngeal tract
Posted Mar 31 2010 3:00am
Nasogastric tube placement is one of the most uncomfortable procedures in the Emergency Department. Why can't we find a painless way to do this?
Now that I am doing more fiberoptic nasopharyngoscopes, this issue is coming up more and more frequently. I've been using NP scopes mainly to check for laryngeal edema in the setting of angioedema. These recent photos visualize a normal epiglottis and normal laryngeal anatomy, respectively.
Tricks of the trade: Anesthetizing the nasopharyngeal tract There is no pain-free way to place NG tubes and insert NP-scopes, but this 2-step approach worked amazingly well in my last patient in whom we performed a NP-scope.
Nebulized lidocaine
I use 4 cc of 4% lidocaine in a nebulizer unit and face mask.
Viscous lidocaine
I inject about 5 cc of 2% viscous lidocaine into a nostril. The patient "snorts in" the lidocaine.
Yes, this 2-step process takes a little more time. If time permits, these extra few minutes are worth it. Just be sure to perform the procedure immediately after the nebulizer treatment is completed. The topical lidocaine wears off quickly.
Now that I am doing more fiberoptic nasopharyngoscopes, this issue is coming up more and more frequently. I've been using NP scopes mainly to check for laryngeal edema in the setting of angioedema. These recent photos visualize a normal epiglottis and normal laryngeal anatomy, respectively.
Tricks of the trade: Anesthetizing the nasopharyngeal tract
There is no pain-free way to place NG tubes and insert NP-scopes, but this 2-step approach worked amazingly well in my last patient in whom we performed a NP-scope.
The patient "snorts in" the lidocaine.
Yes, this 2-step process takes a little more time. If time permits, these extra few minutes are worth it. Just be sure to perform the procedure immediately after the nebulizer treatment is completed. The topical lidocaine wears off quickly.