Tricks of the Trade: A-Line Kits for Vascular Access

Ever struggle with vascular access?

Ever tried a 20G A-Line kit?

Even if you have,  once a flash is obtained it is common to not be able to thread the wire. If you pull the needle out of the catheter, it is rigid and difficult to replace in the catheter and rarely results in salvaging the attempt. In this video, I show you that by cutting the white cap off the back of the a-line kit, it will liberate the guide wire allowing the proceduralist to use it as a backup if the first attempt at placing the catheter fails. I have found,  many times when a flash is obtained but the wire doesn’t pass, the attempt can be salvaged with this technique. Enjoy…

 

CITW 8: A Painful Eye

Welcome back to another Clinical Image of the Week from the case files of the Brown EM Residency!

HPI: 47 year old male with a history of DM and HTN presents to the ED with a painful and red left eye, worsening over the past 24-36 hours.  It is associated with blurred vision, photophobia, headache, a foreign body sensation, and drainage. He tried saline drops without relief. He’s never had this before. He denies any trauma to the eye, although states he did leave his contacts in two nights ago. He denies fevers, chills, or any other associated symptoms.

Vitals: BP 156/87, HR 87, T 98.9 °F, RR 14, SpO2 100 % on RA

Notable PE: Visual acuity (R 20/30 L 20/50). EOMI intact, but painful. Pupils 3 mm and reactive. Lids everted and swept revealing no foreign bodies. Visual fields intact. Normal accommodation. Left eye findings below:

Eye
What’s the diagnosis?
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