Top 10 tips to building a productive academic team

I have been meaning to share this list of great tips about building a productive academic team. Major projects often require an interdisciplinary team of experts who are equally motivated towards a shared goal. I was recently at the 2012 Society of Academic Emergency Medicine where Dr. William McGaghie gave an inspiring CDEM keynote speech. He has been on a myriad of successful academic teams and he shared with us his top 10 list of pearls for team-building.

(more…)

By Michelle Lin, MD|2019-01-28T22:21:18-08:00Jun 18, 2012|Medical Education|

Paucis Verbis: Toxic alcohols – Methanol

Continuing on the theme of Toxic Alcohols (osmolal gap, ethylene glycol), this Paucis Verbis card focuses on methanol toxicity. Useful are the American Academy of Clinical Toxicologists recommendations on when to administer an antidote (fomipezole) and when to perform hemodialysis. I redrew the flowchart based on what’s relevant to the ED in the initial stages.

(more…)

By Michelle Lin, MD|2021-10-19T19:44:59-07:00Jun 15, 2012|ALiEM Cards, Tox & Medications|

Trick of the Trade: "Punch out" the foreign body

A patient re-presents to the Emergency Department with a foreign body sensation in his heel after stepping on a broken window. Despite a negative xray and bedside ultrasound yesterday, the patient still believes that a small foreign body is still in there. You are unable to find a foreign body despite excising the overlying skin with a scalpel and exploring with forceps.

(more…)

By Michelle Lin, MD|2016-11-11T18:44:37-08:00Jun 12, 2012|Tricks of the Trade|

Paucis Verbis: Toxic alcohols – Ethylene glycol

Following last week’s Paucis Verbis card on calculating the osmolal gap, here is the first installment of the Toxic Alcohols cards. First up — ethylene glycol. There are useful American Academy of Clinical Toxicologists recommendations on when to administer an antidote (fomipezole) and when to perform hemodialysis.

Here’s a quick review of the metabolism of the different toxic alcohols. The parent compounds for ethylene glycol and methanol are innocuous and the metabolites are toxic.

PV Card: Ethylene Glycol Toxicity

Adapted from [1-3]
Go to ALiEM (PV) Cards for more resources.

See Dr. Leon Gussow’s great review on The Poison Review and tips of a recent Annals of EM4 paper on identifying a small subset of patients with ethylene glycol who did well despite NOT receiving hemodialysis.

References

Kraut J, Kurtz I. Toxic alcohol ingestions: clinical features, diagnosis, and management. Clin J Am Soc Nephrol. 2008;3(1):208-225. [PubMed]
Jammalamadaka D, Raissi S. Ethylene glycol, methanol and isopropyl alcohol intoxication. Am J Med Sci. 2010;339(3):276-281. [PubMed]
Marraffa J, Cohen V, Howland M. Antidotes for toxicological emergencies: a practical review. Am J Health Syst Pharm. 2012;69(3):199-212. [PubMed]
Levine M, Curry S, Ruha A, et al. Ethylene glycol elimination kinetics and outcomes in patients managed without hemodialysis. Ann Emerg Med. 2012;59(6):527-531. [PubMed]

By Michelle Lin, MD|2021-10-10T08:59:56-07:00Jun 8, 2012|ALiEM Cards, Tox & Medications|

Trick of the Trade: Hair tourniquet release

A 3 month old baby presents with distal erythema and swelling of one of her toes. A hair tourniquet is identified. Typically one can try manually unwrapping the tourniquet using forceps, but often only part of the tourniquet can be removed. The distal toe remains swollen and erythematous with delayed capillary refill.

As demonstrated by the image above, it can be difficult to identify the hair because of the edema and the thin nature of the hair (especially if the same as the patient’s skin color). In a 2006 review of hair tourniquets in the Annals of Plastic Surgery, they recommend incising down to the bone along the lateral edge of the digit to ensure tourniquet release. It seems a bit aggressive…
(more…)

By Michelle Lin, MD|2021-05-15T10:02:11-07:00Jun 5, 2012|Tricks of the Trade|

Paucis Verbis: Approach to increased osmolal gap

We often talk about calculating the anion gap in the evaluation of patients. What about the osmolal gap? When do you calculate this? What’s the differential diagnosis for an increased gap?

I recently came upon a nice 2011 review in the American Journal of Kidney Disease called “Approach to the evaluation of a patient with an increased serum osmolal gap and high-anion-gap metabolic acidosis”. It’s always nice to revisit and review this concept. You’ll always learn something new. For instance, I didn’t know that salicylates cause anion gaps as well as osmolal gaps.

So don’t forget to calculate an osmolal gap for patients with an unexplained metabolic acidosis anion gap.

PV Card: Approach to Osmolal Gap

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

Reference

Kraut J, Xing S. Approach to the evaluation of a patient with an increased serum osmolal gap and high-anion-gap metabolic acidosis. Am J Kidney Dis. 2011;58(3):480-484. [PubMed]

By Michelle Lin, MD|2021-10-10T18:55:20-07:00Jun 1, 2012|ALiEM Cards, Tox & Medications|

Survey: Why do you use Twitter?

I recently got a comment on the blog asking why people need to use Twitter, if they’re already following blogs. I thought I would open this up to the blogosphere.

I personally use my Twitter account (@M_Lin) for a variety of reasons:

I tweet the link to my blog whenever there is a new post (I just tweeted a link to this post!)
Scan quick, real-time information from clinicians I trust
Know “what’s hot” in EM, medical education, and education technologies
Learn of new blogs and websites which I didn’t know about
Quickly check tweets on-the-fly on my iPhone during downtimes
Make new friends who I then meet in person at EM conferences!

Please comment below and include your Twitter name, if possible. I’d love to know why (or why you don’t) use Twitter.

By Michelle Lin, MD|2019-01-28T22:20:36-08:00May 30, 2012|Social Media & Tech|

About Michelle Lin, MD

PV Card: Ethylene Glycol Toxicity

References

PV Card: Approach to Osmolal Gap

Reference