There is significance in the things we carry.¹

The objects we choose to fill a limited space reflect a lot about the lives we lead, the way we think, what we anticipate, and what we prioritize. The hierarchical culture in academic medicine dictates that as we advance in seniority, we carry less. Think about the medical student on rounds whose pockets are stuffed with all manner of items compared to  the attending who carries nothing more than a phone, eschewing even a pen or stethoscope to the burden of others.

The fanny pack (or, as some apologists may argue, “utility satchel”) has become an increasingly popular option to haul around hard-to-find materials out of convenience or necessity. As they have become a more familiar sight in the emergency department, it’s been an interesting experience to see what others carry in their fanny packs and their motivations for carrying them.

Burrow Ink Test

A burrow ink test—also known as an ink burrow test— is a decades old method used to diagnose scabies. A cartridge pen, which has free-flowing ink, or a skin marker, is used to rub ink on the suspected scabies papule. Excess ink is wiped off with an alcohol pad and remaining ink will have penetrated any existing burrows under.^1,2

Panel a. Classic dermatoscopy image of “triangle sign,” which corresponds to the anterior part of the mite (black arrows). Magnification × 10. Panel b. Burrow ink test: staining of the same lesion with washable blue ink. Without magnification, a clear outline and classic S-shaped burrow. Panel c. Polarized dermatoscopy (× 10) after ink staining. The “mother” mite is visible to the extreme side of the burrow (black arrow). Also, many eggs are evident (short red arrows). From Del Barrio-Díaz, P., Vera-Kellet, C. The Burrow Ink Test: a simple method to improve the diagnosis of scabies. J Gen Intern Med. 2022. Reprinted with permission from Springer Nature. (Click to enlarge.)

References

1. De Caprariis PJ, Della-Latta P. Additional techniques for diagnosing scabies. Am Fam Physician. 2013 Apr 15;87(8):536.
2. Woodley D, Saurat JH. Burrow Ink Test and the scabies mite. J Am Acad Dermatol. 1981;4(6):715-722.

For some, it’s an easy extension of a habit inculcated in daily life, a purely utilitarian practice born out of a series of lost phones, IDs, or wallets that has turned into a crucial part of feeling ready for the familiar chaos of the emergency department. It saves time searching for needed items in a rushed situation and saves recreating the trope of fumbling for keys in a critical moment. For others, it may serve as a symbol of equality: The emergency department is the great equalizer of health care, and even attending physicians need to remain grounded, accountable, and most of all, prepared.

Below is a list of 10 essentials that should accompany every emergency department fanny pack, distilled from peer feedback, personal experiences, and extensive literature review. We tried to include items that serve multiple uses, might run out of stock, or can save an unnecessary walk to the supply room. Some of these items may not be relevant to everyone’s practice. Excluded are trauma shears and stethoscope, as well as key items for niche scenarios.

1. 10 cc Syringe 

One of the most versatile items in the emergency department, this handy syringe can easily be Macgyvered in a wide range of clinical emergencies, including inflating an endotracheal tube cuff during an intubation, performing Valsalva maneuvers for patients presenting with supraventricular tachycardia (SVT), leaving “syringe hickey” landmarks via negative pressure lumbar punctures, bolusing medications from the pump, or facilitating reductions of temporomandibular joint dislocations.^2-4  

2. Three-way Stopcock 

This can be used for bedside bubble studies to evaluate for patent foramen ovale or confirm central line placement, set up for nerve blocks, rapid bolus pushes in pediatric resuscitations, adenosine administration for SVT, push-dose pressors, and push-pull IV fluids.^5-8

3. Lubricating Jelly 

One to three packets of lubricating jelly can be useful for rectal exams, endocavitary exams, or as ultrasound gel in a pinch. It is also helpful for inserting airways, Blakemore tubes, nasogastric tubes.

4. Surgical Pen 

Surgical pens are not just for demarcating cellulitis, but also for marking airways for cricothyroid membrane localization. They also can be used for burrow ink test to rule out scabies (see Sidebar), to draw diagrams on patient bedsheets for discharge instructions, and to sign ECGs.⁹   

5. Tongue Depressor 

These are not just for intraoral evaluations; the tongue depressor can be used to assess for mandibular fractures or rigged to create a makeshift nasal clip for anterior epistaxis.^10,11

6. Tegaderm 

Tegaderm works as an ultrasound probe cover in a pinch; although, this may spark debate. It is also great for peripheral IV placement, to have as part of your suture kit, to use as a bandage, and as a protective eyelid covering for bedside ocular ultrasound exams.^12,13

7. Alcohol Swab 

Not only do alcohol swabs clean your phone, stethoscope, or other wearable equipment, but they also can serve as impromptu packets for nausea relief. They are great for patients who may be maxed out on ondansetron, haloperidol (Haldol)/droperidol, and other multimodal nausea approaches.¹⁴

8. Tape

This is one of those items that seems ubiquitous except when most needed. Use for peace of mind on hard secured lines you don’t want to lose, such as easily displaced ECG leads..

9. A Single Quarter

The width of a single quarter easily fits into the groove of most emergency department bathroom door handles to allow for access in a pinch (see: seizing patient in the bathroom, extended or unlawful occupancy). It can also serve as a clinical decision tool in the rare event of choosing between two equally well-thought-out plans.

10. #10 Blade Scalpel

This is important because you never know when you’ll need to perform a surgical airway.^15,16

What are your 10 essentials on shift?

Dr. Park is a faculty physician at Henry Ford Hospital, Detroit, Mich., where he completed his advanced emergency ultrasound fellowship. His clinical interests include regional nerve blocks and ultrasound-guided vascular access

Dr. Cherukupalli is an emergency medicine resident at Henry Ford Health in Detroit, Mich.

References

1. Park AJ. Things we carry. Ann Emerg Med. 2022;79(5):498-499.
2. Appelboam A, Reuben A, Mann C, et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. Lancet. 2015;386(10005):1747-1753.
3. Issa EC, Ware PJ, Bitange P, et al. The “Syringe Hickey”: an alternative skin marking method for lumbar puncture. J Emerg Med. 2023;64(3):400-404.
4. Gorchynski J, Karabidian E, Sanchez M. The “syringe” technique: a hands-free approach for the reduction of acute nontraumatic temporomandibular dislocations in the emergency department. J Emerg Med. 2014;47(6):676-681.
5. Montrief T, Lin M, Weingart S. Trick of the trade: bubble study for central line placement. Academic Life in Emergency Medicine. Published August 21, 2013. Accessed April 28, 2025.
6. Olshansky M, DeStefano K, Khordipour E. Trick of the trade: ultrarapid adenosine push for SVT with a pressure bag. Academic Life in Emergency Medicine. Published June 24, 2024. Accessed April 28, 2025.
7. Thoreczako. Push Dose Epi. Pediatric Emergency Medicine Playbook. Published January 1 2023. Accessed June 6, 2025.
8. Miyawaki IA, Gomes C, Caporal S Moreira V, et al. The single-syringe versus the double-syringe techniques of adenosine administration for supraventricular tachycardia: a systematic review and meta-analysis. Am J Cardiovasc Drugs. 2023;23(4):341-353.
9. Rauwerkink D, Balak D. Burrow ink test for scabies. N Engl J Med. 2023;389: e12.
10. Roth KR, Gafni-Pappas G. Unique method of ocular ultrasound using transparent dressings. J Emerg Med. 2011;40(6):658-60.
11. Neiner J, Free R, Caldito G, et al. tongue blade bite test predicts mandible fractures. Craniomaxillofac Trauma Reconstr. 2016;9(2):121-124.
12. Makeshift Nasal Clip Using Tongue Depressors for Treating Epistaxis. Merck Manuals Professional Edition. Accessed April 28, 2025.
13. Shokoohi H, Armstrong P, Tansek R. Emergency department ultrasound probe infection control: challenges and solutions. Open Access Emerg Med. 2015;7:1-9.
14. Abdullah BJ, Mohd Yusof MY, Khoo BH. Physical methods of reducing the transmission of nosocomial infections via ultrasound and probe. Clin Radiol. 1998;53(3):212-4.
15. Lindblad A, Ting R, Harris K. Inhaled isopropyl alcohol for nausea and vomiting in the emergency department. Canadian Family Physician. 2018;64:580.
16. Nickson C. Surgical Cricothyroidotomy. Life in the Fast Lane. Published July 2, 2024 Accessed June 6, 2025.
17. Rezaie SR. Bougie-Assisted Cricothyrotomy. REBELEM. Published February 26, 2021. Available at: Accessed June 6, 2025.