Trick of the Trade: Ambient noise and creative cognition

For many of us in academia and medical education, we accomplish a tremendous amount of work outside of the workplace. This can be in our home office, on the public transit system, or in the library.

Interestingly, creative cognition occurs best with a moderate amount of ambient noise (not too much and not too little), according to a 2012 article from Journal of Consumer Research.

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By Michelle Lin, MD|2019-02-19T18:04:59-08:00Mar 12, 2013|Tricks of the Trade|

Need your input! PV cards becoming an app

It’s all about luck, opportunity, and timing.

I will be releasing the blog’s first ever Paucis Verbis (PV) native app this year. After a few years of brainstorming and lots of reader inquiries about an app, we were approached by two different app-building companies in the same week. I’m incredibly humbled to be approached by organizations, who can see the potential of these pocket cards (which started as actual index cards while I was in residency). It is an incredibly exciting time to be in the world of education and social media!

I need your help with step 1.

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By Michelle Lin, MD|2017-03-05T14:14:30-08:00Mar 12, 2013|ALiEM Cards, Social Media & Tech|

Patwari Academy videos: Chest trauma

In the third and fourth video in the Trauma series (first two videos = primary and secondary survey), Dr. Rahul Patwari discusses about chest trauma, divided into blunt and penetrating mechanisms. What is “the box” that everyone keeps referring to?

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By Michelle Lin, MD|2019-01-28T22:04:15-08:00Mar 10, 2013|Patwari Videos, Trauma|

Patwari Academy videos: Trauma primary and secondary survey

What’s the primary and secondary survey in the assessment of the trauma patient? This is a great review of the methodical approach and insight in the thought processes by Dr. Rahul Patwari.

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By Michelle Lin, MD|2019-01-28T22:04:30-08:00Mar 3, 2013|Patwari Videos, Trauma|

Built a 20-person worldwide educator panel in two hours

Yesterday I had the pleasure of sharing my thoughts to an enthusiastic crowd of UCSF preclinical medical students on one of my favorite topics “Technology and Social Media in Emergency Medicine”. This is the perfect target audience to teach about developing a workflow habit for keeping up with digital information, since they are only starting to grow their clinical knowledge foundation.

On the morning of my noon talk, I regretted not recruiting some fellow FOAMed (Free Open Access Meducation) supporters to email me their thoughts about why social media is here to stay in medical education. How great would it have been to share the collective thoughts of leaders in this area?

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By Michelle Lin, MD|2019-01-28T22:04:39-08:00Feb 28, 2013|Medical Education, Social Media & Tech|

Trick of the Trade: Use the angiocatheter for central lines

Central lines come packed with a long introducer needle (pink arrow) to feed the guidewire through AND a long angiocatheter (yellow arrow). Most people cannulate the vein by using the syringe and the introducer needle. What’s the angiocatheter for?

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By Michelle Lin, MD|2019-02-19T18:04:54-08:00Feb 26, 2013|Tricks of the Trade|

PV card: Bell’s Palsy Treatment

Bell’s Palsy is an idiopathic unilateral facial nerve paralysis.

Since the 2009 Cochrane review¹ showing that antivirals added no benefit to corticosteroids in Bell’s Palsy, I stopped prescribing them. The NNT.com site has concluded the same. Looking at the literature a little more, the recommendations are a little murkier. Some groups are still advocating for antivirals for severe cases, because there may be a very small but questionably positive benefit.

“Because of the possibility of a modest increase in recovery, patients might be offered antivirals (in addition to steroids) (Level C). Patients offered antivirals should be counseled that a benefit from antivirals has not been established, and, if there is a benefit, it is likely that it is modest at best”²
UpToDate: “For the subgroup of patients with severe facial palsy at presentation, defined as House-Brackmann grade IV or higher, we suggest early combined therapy with prednisone (60 to 80 mg per day) plus valacyclovir (1000 mg three times daily) for one week rather than glucocorticoids alone (Grade 2B).”
“The authors conclude that although a strong recommendation for adding antiviral agents to corticosteroids to further improve the recovery of patients with severe Bell palsy is precluded by the lack of robust evidence, it should be discussed with the patient.”³
“Antiviral agents, when administered with corticosteroids, may be associated with additional benefit.”⁴

PV Card: Treatment of Bell’s Palsy

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Adapted from [1, 2, 4]
Go to ALiEM (PV) Cards for more resources.

Thanks to Dr. Kristin Berona (UCSF-SFGH EM resident) for the idea and notes!

References

Lockhart P, Daly F, Pitkethly M, Comerford N, Sullivan F. Antiviral treatment for Bell’s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2009;(4):CD001869. [PubMed]
Gronseth G, Paduga R, American A. Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2012;79(22):2209-2213. [PubMed]
van der, Rovers M, de R, van der. A small effect of adding antiviral agents in treating patients with severe Bell palsy. Otolaryngol Head Neck Surg. 2012;146(3):353-357. [PubMed]
de A, Al K, Guyatt G, et al. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. JAMA. 2009;302(9):985-993. [PubMed]

By Michelle Lin, MD|2026-06-16T16:02:00-07:00Feb 21, 2013|ALiEM Cards, Neurology|

About Michelle Lin, MD

PV Card: Treatment of Bell’s Palsy

References