In response to my recent "Pain in the Ass" post, in which the subject was a simple procedure bringing rapid and dramatic relief, commenters have mentioned other similar interventions. Seems like a fun topic. Here's a list I can think of (a couple of which are those mentioned in the comments, by readers.) Anyone want to chime in with others?
- Giving "Narcan" to an overdose patient: within seconds a moribund and blue, pin-point-pupilled addict is transformed to a yelling and screaming maniac.
- Similarly: Dextrose IV for hypoglycemia rapidly raises from unconsciousness to lucidity.
- Relieving a subungual hematoma with the red-hot tip of a straightened and heated paper clip. FZZZT, and the patient is happy!
- Draining any sort of painful abscess under local: pilonidal, perianal. The patient has arrived in abject pain, hardly able to walk, and leaves smiling and light on his feet.
- Releasing a tension pneumothorax with a needle. FZZZT, and the patient is happy!
- Reducing a dislocated shoulder: the water-bucket trick is rewardingly direct, low-tech, and effective. Pop >>> ahhh!
- Pulling back a too-far inserted endotracheal tube. The oximeter tone rises steadily.
- Untwisting a sigmoid volvulus with a scope. Stand back, or let someone else do it. Dramatic to all senses.
- Cricothyroidotomy. Too scary to be fun, it certainly qualifies as dramatic and effective, especially when done with nothing but a large IV catheter.
- Sticking a finger onto a major bleeding artery, the kind you can hear. It doesn't solve the problem but it sure as hell is a relief for the moment. When the natural instinct is to turn the head away, which some in the assemblage might do, it seems sort of heroic.
- Squeezing bags of fluid or blood with both hands, and seeing the blood pressure rise and pulse fall within moments.
- Carotid sinus massage: I actually did it once, for atrial flutter with syncope, absent readily available meds. I kept thinking I'd cause a stroke, and never had to do it again. Still, it's a nice maneuver based on medical school knowledge of cardiovascular physiology.
- Opening a chest and pericardium, of course, and poking a finger into a heart wound. Been there, done that. Not so simple, but uber-dramatic. Relieving pressure in a pericardium by whatever means can resurrect a person in an instant.
- Quickly accessing the subclavian vein. Simple. But often tricky enough that when you pop in the needle and get a nice flashback of blood in a couple of seconds, it feels pretty good.
- Inserting a suprapubic bladder catheter when you can't get a foley to pass.
- Apocryphal, perhaps? Everyone says it happened in their ER: giving sux to a hopelessly combative patient. Calms them right down.
- Administering valium for status epilepticus.
- Anyone perform/experience others?
