For today’s POTD, I wanted to share a couple hacks I’ve collected from others over my residency that may make Mondays a bit more manageable.
#1 Stockinette (and yes, I too thought there was a “g” in there) Arm Sling
Have you ever been working a busy Peds ED shift and come across a young’n with an injury requiring a sling? You walk around looking for a tiny human sized sling for the 3 year old and feel like it’s an issue that we don’t have anything small enough. Spoiler alert: the real issue is that no 2 year old is going to keep their arm still BUT you should still do your best to at least try and properly immobilize/sling them.
Thanks to Eric Lee who taught me this, we can actually fashion a tiny human sized sling using stockinette!
Just cut a long piece of stockinette of width that will be tight enough around the little arm to give it a good hugging feeling. The length should be about 2.5-3 length of the entire arm (shoulder to hand). Once you’ve measured this, cut a slit into one side of the stockinette that extends a little less than half the length of the tube. Simply place the child’s arm inside the stockinette tube with the cut side towards the head and this will nestle just below the axilla, wrap the cut part around the child’s trapezius area where you will tie a knot at the nape of the neck or just on the unaffected shoulder area which connects the part with the arm inside.
See this website for another way to macgyver a teeny sling - this one seemingly provides better immobilization: https://www.chp.edu/our-services/plastic-surgery/resources/brachial-plexus
Bonus: this is adorable - especially on babies ❤
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#2 Fluorescein Eye Drops
Imagine being a patient coming into the ED with excruciating eye pain and being told that someone is going to stick a piece of paper into your already searing eyeball and then look at it with a fancy named lamp that turns out is actually just a black light.
There are a couple ways to effectively and less painfully deliver the fluorescein dye needed for a Wood’s lamp exam.
First, you can simply use the tetracaine drops and drop them onto the fluorescein strip and let that liquid fall into the patient’s eye. This can sometimes be challenging given that they often have a hard time keeping their eyelids open and you’ll need both your hands to use this technique.
Second, you can use tetracaine and simply place the fluorescein strip directly into the eye just under the bottom eyelid. This works too but again, it may be sensitive and there is a chance there is a foreign body hiding under that lid that may be more irritated by the paper you placed there.
Lastly (and this is my personal favorite), grab a 3 or 5ml syringe, a flush and a fluorescein strip. Open the empty syringe and remove the plunger. Take off the cap from the flush and place it on the empty, plunger-less syringe. Rip off the end of the fluorescein strip containing the dye and place it in the cylinder of the empty syringe. Squirt 1-2cc of the flush into the empty syringe. You’ll notice the fluid will become fluorescent yellow. Replace the plunger (you’ll have to flip it over and remove the cap on the other side in order to advance it) and voila! You now have fluorescein eye drops! I like this because it also allows you to use it again in the case that you need to repeat your exam and is generally less uncomfortable than putting a piece of paper in someone’s eye.
I hope these simple hacks aid you on your quest to conquer Peds and Fasttrack! Let me know if you have any other ED hacks you think are worth sharing, I know we all get inventive and it’s fun to hear what people have found works well!