26 11, 2014

Trick of the Trade: Pediatric video laryngoscope for ear foreign bodies

By |November 26th, 2014|ENT, Tricks of the Trade|2 Comments

tweezerIt is near the end of your shift and one of the nurses asks you to see a fellow ED staff member’s nine-year old daughter who has accidentally put a foreign body into her ear. You go see her and the otoscope reveals a small shiny jewel within the ear canal however flushing does not work to get it out. Next you try using the otoscope, while exposing the ear canal and holding the forceps to grasp the object. Unfortunately, it is difficult to get your assistant to align the light, and the otoscope speculum is limited in view and access.

24 11, 2014

Can Permanent Marker Leach into IV Infusion Bags?

By |November 24th, 2014|Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical), Tox & Medications|0 Comments

IVBag

You are resuscitating a hypotensive patient with severe sepsis and have just hung your 4th liter of crystalloid. On the fluid bags, you wrote the numbers 1 through 4 in permanent marker to help keep track of your resuscitation. As you finish placing your central line the charge nurse enters the room. He informs you that according to the Institute for Safe Medical Practices (ISMP), writing directly on IV bags with permanent marker is not recommended due to concerns that the ink will leach into the bag and potentially cause harm to your patient [1-4].

This situation raises several questions:

  1. Should we write on IV bags in permanent marker?
  2. Is there a possibility of ink diffusing through polyvinylchloride (PVC) bags?
  3. If so, is there potential harm to the patient?
23 11, 2014

I am Oliver Flower, an Intensive Care Specialist: How I Work Smarter

By |November 23rd, 2014|How I Work Smarter|0 Comments

How I Work Smarter LogoIn the world of medical education and Twitter, Dr. Oliver Flower (@OliFlower) is a virtual celebrity. Oli has been a central figure in FOAM and serves the daunting role of being a co-organiser for the upcoming buzz-worthy SMACC conference in Chicago (June 23-26, 2015) alongside Roger Harris and Chris Nickson. He is incredibly efficient and effective, juggling multiple deadlines and responsibilities. It was no surprise to us when Oli was tagged by Dr. Rob Mac Sweeney from a previous How I Work Smarter post as someone whom we could learn a lot from. Oli was kind enough to send along his responses.

 

21 11, 2014

ALiEM Bookclub: Humble Inquiry

By |November 21st, 2014|ALiEM Book Club, Medical Education|8 Comments

3148In this month’s ALiEM Book Club selection, Humble Inquiry: The Gentle Art of Asking Instead of Telling, author Edgar Schein describes a model of communication termed “humble inquiry” which he defines as “the fine art of drawing someone out, of asking questions to which you do not already know the answer, of building a relationship based on curiosity and interest in the other person”. Although a very quick read (100 short pages!), it is packed with profound insights about the way we communicate and a vision for what might be! Communication is so pertinent to our work in the medical field from encounters with our colleagues, our learners, and our patients. Striving to improve communication is a goal that every provider should have and this powerful book can help!

20 11, 2014

Ultrasound For The Win! Case – 93F with Chest Pain

By |November 20th, 2014|Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical), Ultrasound|0 Comments

Welcome to another ultrasound-based clinical case, part of the “Ultrasound For The Win!” (#US4TW) Case Series! In this peer-reviewed case series, we focus on real clinical cases where bedside ultrasound changed the management or aided in diagnoses. In this month’s case, a 93-year-old female presents to the Emergency Department with crushing chest pain.

CASE PRESENTATION

A 93-year-old female with no available medical history is brought to the Emergency Department by ambulance after she was noted to clutch her chest and collapse while at home. She is unable to provide any history due to altered mental status.

19 11, 2014

Why Henderson and Hasselbalch Belong in the ED

By |November 19th, 2014|Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical)|5 Comments

the_big_question_9192If you’re like me, you learned and then promptly forgot the Henderson Hasselbalch equation (HH eq) in medical school [1]. After all, in clinical rotations it was never invoked, and our patients seemed to have fared well without it. So why bring up the topic now?

Medicine is changing. The ubiquitous nature of computing allows a level of sophistication exponentially greater than before. To a large extent we’re freed from much of the onerous work of rote memorization. In the ideal, that should free us to be more thoughtful about the way we approach our work and to have a deeper understanding of health and disease. Going forward, medicine will become increasingly computational. With that in mind, I’ll make three points about the HH eq.

17 11, 2014

Trick of the Trade: Naloxone Dilution for Opioid Overdose

By |November 17th, 2014|Tox & Medications|9 Comments

NaloxoneTraditional teaching recommends naloxone doses of at least 0.4 mg IV to reverse opioid toxicity. Drs. Lewis Nelson (@LNelsonMD) and Mary Ann Howland (@Howland_Ann) co-authored the opioid antagonist chapter in Goldfrank’s Toxicologic Emergencies [1]. They write:

“However, this dose [0.4 mg] in an opioid-dependent patient usually produces withdrawal, which should be avoided if possible. The goal is to produce a spontaneously and adequately ventilating patient without precipitating significant or abrupt opioid withdrawal. Therefore, 0.04 mg is a practical starting dose in most patients, increasing to 0.4 mg, 2 mg, and finally 10 mg.”

15 11, 2014

EM Match Advice: Post Interview Communications

By |November 15th, 2014|EM Match Advice|3 Comments|Tags:

EM Match iconWith interview season now in full swing this winter season, we gathered a few more of our favorite program directors to discuss the hot topic of making the post-interview communication etiquette. We feature Dr. Jim Colletti (Mayo Clinic), Dr. Jessica Smith (Brown University), and Dr. Jeff Schneider (Boston Medical Center). Thanks again to Dr. Mike Gisondi (Northwestern) for spearheading this innovative and helpful EM Match Advice video series for medical students.

10 11, 2014

ALiEM-Annals of EM Journal Club: Spontaneous pneumothorax, pigtail catheters, and outpatient management

By |November 10th, 2014|Journal Club with Annals EM, Pulmonary|24 Comments

ALiEM-AnnalsEM-SquareWe are very excited this month to bring you another installment of the ALiEM-Annals of EM Global Journal Club. The highlighted article is Voison et al. on the “Ambulatory Management of Large Spontaneous Pneumothorax With Pigtail Catheters.” We hope you will participate in an online discussion based on the clinical vignette and questions below from now until Nov 17, 2014. These Respond by commenting below or tweeting using the hashtag #ALiEMJC. In a few months, a summary of this journal club will be published in Annals of EM.

On Fri, Nov 15, 2014, we hosted a live Google Hangout with Dr. Stéphane Jouneau, the senior author of the Annals of EM publication who resides in France.

9 11, 2014

I am Dr. Teresa Chan, ALiEM Associate Editor/BoringEM Managing Editor: How I Work Smarter

By |November 9th, 2014|How I Work Smarter|0 Comments

How I Work Smarter LogoI her original post for the “How I Work Smarter” series, Editor-in-Chief Michelle Lin (@M_Lin) called out Dr. Esther Choo (@choo_ek), who then called out Dr. Lainie Yarris (@lainieyarris) from OHSU… and in an unexpected turn of events, Lainie then somehow decided to tag me. How odd… Lainie is a mentor of one of my friends, and she’s been kinda a hero to me, so I find that this is both flattering and somewhat flabbergasting… There is no way I fit within the ranks of those others’ whom have been tagged in this wonderful game of academic “you’re it…”, but as the great Barney Stinson once said: “Challenge accepted.”