Trick of the Trade: Less traumatic nasopharyngoscopy

A fiberoptic nasopharyngoscope is a handy tool to check patients for suspected foreign bodies (e.g. fishbone stuck in throat) or laryngeal edema. Depending on the diameter of your fiberoptic cable, it may be fairly uncomfortable for the patient despite generous viscous lidocaine instillation through the nares and nebulized lidocaine. Alternatively or additionally, you can make your own lidocaine-oxymetazoline nasal atomizer which works well.

What if the patient is STILL not tolerating the procedure well?

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By Michelle Lin, MD|2016-11-11T19:02:31-08:00Jul 16, 2013|ENT, Tricks of the Trade|

Patwari Academy videos: Neonatal Resuscitation

What is your approach to neonatal resuscitation… that is, after you pause a millisecond to first take a deep breath. Stay calm in this always stressful scenario. Dr. Rahul Patwari goes over the basics from the 2010 Circulation publication on Neonatal Resuscitation (free PDF). What should you be thinking of and doing in the first “golden minute”?

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By Michelle Lin, MD|2019-01-28T21:58:43-08:00Jul 14, 2013|Patwari Videos, Pediatrics|

Trick of the Trade: Stimson technique using wrist restraints

A patient presents with an anterior shoulder dislocation on x-ray. Your ED just received 5 new patients via ambulance and you are trying to prioritize your patients as they come in the door. What can you do for your patient with the shoulder dislocation in the meantime? (more…)

By Michelle Lin, MD|2016-11-11T19:02:30-08:00Jul 10, 2013|Orthopedic, Tricks of the Trade|

Sign a petition: A public IN CASE OF EMERGENCY iPhone option

Hi, we’re Ben Friedman and Sara LaHue! We are third-year UCSF medical students who are passionate about using technology to improve access to medical care. We have both witnessed the difficulties of treating someone who presented to the Emergency Department whose identity or emergency contact was unknown. Think of these sample scenarios:

A commercial plane crashes and injured, non-English speaking children are separated from their parents.
A bicyclist is critically injured after being hit by a bus but comes with no identification information.
A teenager requires intubation for status asthmaticus before we could obtain her emergency contact information.
An elderly patient with dementia is found wandering the city streets with only an iPhone on him.

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By Michelle Lin, MD|2016-11-11T19:02:28-08:00Jul 8, 2013|Social Media & Tech|

Patwari Academy videos: The Crashing Neonate

In this series of videos, Dr. Rahul Patwari reviews the approach to the crashing neonate. Because these cases are often stressful, it is paramount to keep in mind a broad list of potential causes, such as “THE MISFITS” mnemonic:

T rauma/abuse
H eart disease
E ndocrine (CAH, hyperthyroid)
M etabolic (hypoglycemia, hyponatremia)
I nborn errors
S epsis
F ormula mishaps
I ntestinal catastrophes
T oxins (home remedies)
S eizures

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By Michelle Lin, MD|2019-01-28T21:58:31-08:00Jul 7, 2013|Patwari Videos, Pediatrics|

Welcome new series Geriatric EM by Dr. Christina Shenvi

Welcome a new superstar blogger, Dr. Christina Shenvi (@clshenvi), to the ALiEM team. If there’s one talent I have, it’s spotting the rising academic star. As the new Geriatrics EM fellow at the University of North Carolina, she’ll be starting her monthly series of blog posts on Geriatric EM. I jumped at the chance when she came up with the idea of this series, since there is never enough teaching about the unique aspects in the emergent care of older patients. Since meeting her in March 2013 at the annual CORD meeting, it’s been the longest 4 months anxiously waiting (and waiting, and waiting) for her to start her Geriatric EM fellowship and contributing blog articles.

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By Michelle Lin, MD|2019-01-28T21:58:18-08:00Jul 1, 2013|Geriatrics|

Patwari Academy videos: Anticoagulation and reversal agents

Bleeding in general is bad. Bleeding while on anticoagulants is VERY bad. Dr. Rahul Patwari reviews the pathophysiology of coagulation, the various reversal agents, and treatment approaches we can use. In this five-part series where all videos are less than 10 minutes, Rahul goes from the basic physiology of coagulation all the way to the complex reasoning and approaches to reversing anticoagulants. These are worth a quick look and review.

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By Michelle Lin, MD|2019-01-28T21:57:58-08:00Jun 30, 2013|Heme-Oncology, Patwari Videos, Tox & Medications|