Paucis Verbis: D-Dimer test

D-Dimer: To order or not to order?

That’s the question when it comes to risk stratifying a patient for a pulmonary embolism with a low pretest probability. One should consider confounding conditions which may cause an elevated D-Dimer level. There’s always confusion about what may cause an elevated D-Dimer besides venous thromboemboli. So I thought I would make a pocket card as a reminder.

PV Card: D-Dimer Test

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

Reference

Wakai A, Gleeson A, Winter D. Role of fibrin D-dimer testing in emergency medicine. Emerg Med J. 2003;20(4):319-325. [PubMed]

By Michelle Lin, MD|2021-10-10T08:49:42-07:00Jul 27, 2012|ALiEM Cards, Cardiovascular, Pulmonary|

Video: A primer on social media (ICEM 2012)

At the recent International Conference in Emergency Medicine (ICEM), the professorial Dr. Mike Cadogan (Life In The Fast Lane) gave a talk on Social Media in Medicine. Thanks to Dr. Andy Neill (Emergency Medicine Ireland) for recording this. See below for the 36 minute video. Well worth a watch.

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By Michelle Lin, MD|2026-06-16T16:02:35-07:00Jul 27, 2012|Medical Education, Social Media & Tech|

Trick of the Trade: Photograph slit lamp findings

How do you capture the image of the eye on slit lamp exam either for the patient or your ophthalmology consult? It’s often easier to show someone a photo rather than trying to describe that atypical dendritic lesion, degree of corneal edema, or pattern of corneal abrasion.

You, however, don’t have the expensive camera attachment (nor a SLR camera for that matter).

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By Michelle Lin, MD|2019-01-28T22:18:01-08:00Jul 24, 2012|Ophthalmology, Tricks of the Trade|

Trick of the Trade: Removing a Tungsten Ring Stuck on Your Finger

A patient presents with a tungsten ring on their injured finger and is unable to remove the ring. Tungsten rings are unique in that ring cutters can’t even make a scratch in them. There are even anecdotes of firefighter equipment not being able to cut off these “unbreakable” rings.

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By Michelle Lin, MD|2021-05-13T09:37:17-07:00Jul 10, 2012|Tricks of the Trade|

Trick of the Trade: Unblocking the obstructed IV line

A patient’s PICC line becomes obstructed and presents to your ED for care. She is using it for chronic antibiotics for osteomyelitis. You are unable to aspirate and flush it with saline using a 10 cc syringe.

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By Michelle Lin, MD|2022-03-26T14:43:51-07:00Jul 3, 2012|Tricks of the Trade|

Paucis Verbis: Blunt cardiac injury

Do you always get a troponin for patients who sustain blunt chest trauma?

Hopefully your answer is no. Of note, it is also NOT indicated as a screening test for those in whom you suspect a blunt cardiac injury (BCI). It can be normal in the setting of arrhythmias and it can be falsely elevated in the setting of catecholamine release or reperfusion injury from hypovolemic shock.

The initial screening test should include an ECG and a FAST ultrasound exam. If you have abnormal ECG findings, then a troponin is warranted (in addition to hospital admission).

Below summarizes a suggested algorithm from the recent EM Clinics of North America publication series. Definitive statements are challenging because there is no gold standard to diagnose BCI.

PV Card: Blunt Cardiac Injury

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

Reference

Bernardin B, Troquet J. Initial management and resuscitation of severe chest trauma. Emerg Med Clin North Am. 2012;30(2):377-400, viii-ix. [PubMed]

By Michelle Lin, MD|2021-10-10T08:52:32-07:00Jun 29, 2012|ALiEM Cards, Cardiovascular, Trauma|

Tricks of the Trade: Valsalva maneuver by using a 10 cc syringe

Last week, Dr. David Johnson shared his trick to elicit a Valsalva maneuver out of his patient. Here’s another trick that I saw one of our EM residents use in an attempt to break a SVT rhythm.

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By Michelle Lin, MD|2019-01-28T22:21:33-08:00Jun 26, 2012|Tricks of the Trade|

About Michelle Lin, MD

D-Dimer: To order or not to order?

PV Card: D-Dimer Test

Reference

PV Card: Blunt Cardiac Injury

Reference