Twitter is the digital watercooler in Medicine

I just don’t have time to join Twitter. Are you serious, Twitter?

Being in the minority of medical providers who use Twitter for work, these are common responses I hear. I would make the counter argument that it has given me opportunities to learn, collaborate, and share on a much more efficient level.

(more…)

By Michelle Lin, MD|2016-11-11T11:47:55-08:00Dec 16, 2012|Social Media & Tech|

Patwari Academy videos: ACLS and post-resuscitation care

This is the last installment of Dr. Rahul Patwari’s digital whiteboard video talks on ACLS, specifically focusing on post-resuscitation care and therapeutic hypothermia.

Parts 1-3 (ACLS and airway)
Parts 4-6 (ACLS: cardiac arrest)
Parts 7-10 (ACLS: bradycardias and tachycardias)

(more…)

By Michelle Lin, MD|2016-10-26T17:05:07-07:00Dec 16, 2012|Patwari Videos|

PV card: Metacarpal fractures

$metacarpal fracture rotationa angulationa=$ Patients with rotation deformities of the fingers from a metacarpal fracture should be reduced. All fingers should normally point towards the patient’s scaphoid bone.

Metacarpal (MC) fractures are common injuries, which often spark discussions about whether they should be reduced in the ED urgently.

What are the criteria for acceptable degrees of angulation? Are these criteria different for the MC neck versus shaft?
Which fractures tend to be unstable and thus require eventual operative repair?
How should I splint the injury?

Here’s a quick-reference card to help guide your management decisions. These recommendations may vary slightly based on what references you use. You may need to tailor your decisions based on your regional practices.

PV Card: Metacarpal Fractures

<span data-mce-type="bookmark" style="display: inline-block; width: 0px; overflow: hidden; line-height: 0;" class="mce_SELRES_start"></span>
Go to ALiEM (PV) Cards for more resources.

Thanks to Dr. Nicole Strauss at the UCSF-SFGH Orthopaedic Trauma Institute and my go-to hand expert for her input.

By Michelle Lin, MD|2021-10-08T09:33:03-07:00Dec 13, 2012|ALiEM Cards, Orthopedic|

Trick of the Trade: Speed up ECG paper rate to differentiate tachycardias

Undifferentiated tachycardias, especially when the rate is extremely fast, make it difficult to see anything other than the QRS complexes! Is there a P or flutter wave?
(more…)

By Michelle Lin, MD|2019-01-28T22:09:48-08:00Dec 11, 2012|ECG, Tricks of the Trade|

Patwari Academy videos: ACLS (parts 7-10)

What is the definition of bradycardia and tachycardia in the 2010 ACLS guidelines, for the purposes of resuscitation algorithms?

Bradycardia: heart rate < 50 bpm
Tachycardia: heart rate > 150 bpm

(more…)

By Michelle Lin, MD|2019-01-28T22:09:36-08:00Dec 9, 2012|Patwari Videos|

Poll: How would manage a metacarpal fracture in the ED?

$Metacarpal5fracture$

I am in the process of creating a PV card on metacarpal fractures, divided into anatomical areas (base, shaft, neck, head), and am realizing that the EM and orthopedic literature don’t quite agree. Actually they are quite vague on whether reductions should occur in the ED vs orthopedics clinic in the next few days.

Do you need to close-reduce all angulated fractures in the ED, which are outside of “acceptable” angulations?
What exactly are “acceptable” angulations? Some sources say that angulations of 10, 20, 30, and 40 degrees are acceptable for MC neck fractures and only 10, 10, 20, and 20 degrees are acceptable for MC shaft fractures. These numbers, though, vary from reference to reference.

(more…)

By Michelle Lin, MD|2016-11-11T18:43:07-08:00Dec 5, 2012|Orthopedic|

Trick of the Trade: Ultrasound-guided supraclavicular central line

Subclavian central lines are commonly touted as the central line site least prone to infection and thrombosis. The problem is that they are traditionally performed without ultrasound guidance. They are done blindly because of the transducer’s difficulty in getting a good view with the clavicle in the way.