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On "unnecessary" ED visits: background reading

Here are a bunch of very informative pieces on why trying to blame excessive costs or busy-ness on low acuity patients in the ED is, at be...

June 2, 2013


Scott Weingart got me hooked on carrying a Sharpie on shift (nb it should be industrial strength), primarily for marking neck landmarks on people whose airway may deteriorate. He also advocates using it for marking external landmarks for LPs, before they get distorted by local anesthetic and hidden behind a fenestrated drape.

I've since found a few mostly obvious uses:

1) Cric landmarks

2) LP landmarks

3) Paracentesis: find a pocket of fluid with ultrasound, mark with Sharpie. Then sterilize and tap; no need to fumble with sterile US probe.

4) Outlining cellulitis

Some others:

5) Serial or alternate site ECGs:

6) Quick labeling of syringes (pretty much any sticker will work)

7) Alexander Sammel shared this one: marking added meds
8) Chris Edwards adds: signing kids' casts

Any other ideas?


Per Bryan Kitch's suggestion (and kicking myself for not thinking of it):
Also, I got tired of counting out 20 floor tiles every time I used the Snellen chart on the wall:


  1. Also drawing smiley faces on blow up glove toys for kids :)

    1. But which way do you have the hair face?!

  2. Tracing edema and poison track in snake bites. I also mark a tiny x on dopplerable pulse sites

    1. Yes! Great for demarcating *anything* that can spread. I also use for pulse sites, thanks for the reminder!

  3. Marking veins in difficult phlebotomy

  4. marking that a limb has had a nerve block (Mike stone's tip not mine)

  5. Write a number on each of your bags of resus fluid as you hang them - easy visual reminder of how you're doing on fluid balance, and also useful in case EMS therapies mean the first liter you order is actually number 3 or 4 for the patient.

  6. Placing a T for tourniquet, and the time, on the patient's forehead.

  7. I used mine yesterday on pill bottles for a polypharmacy OD. Marked number ingested on each bottle as I went through the pile with the patient

    Also use it for syringes, pulses, multiple pts on an incident, IV bags, and EKGs for multiples or V4R/V7,V8,V9.

  8. For adding allergies on chart (particularly for items such as iv contrast, benzo etc if they are leaving the department).

    Also great for coffee runs so orders don't get mixed up and for labelling whose coffee it is afterwards. (Yes, there is a theme.)