Trick of the Trade: Fluorescein eyedrops

This is a guest post by Dr. Ian Brown (Stanford):

The Roberts textbook describes the procedure of corneal fluorescein staining as touching a moistened fluorescein strip to the cornea. Maybe it is an irrational fear of a paper cut to the sclera, or a fear of touching an already abraded cornea with the paper, but I try to find an alternative. I have seen physicians hold the eye open with one hand, hold the fluorescein with a second hand and then drip tetracaine on the paper and let it drip into the eye with a third hand. I, unfortunately, only have two hands.
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By Michelle Lin, MD|2019-01-28T23:36:28-08:00Mar 27, 2012|Ophthalmology, Tricks of the Trade|

Introducing a new blog: "Modern EM"

Last month, I announced Dr. Timothy Peck (Beth Israel Deaconess EM resident) as one of the winners of the Blog Incubator Contest. Starting today and for the next 2 Mondays, he’ll be posting a 3-part series, which will eventually end up on his blog “Modern EM” at ModernEM.blogspot.com. His blog will feature examples of how Web 2.0 influenced the management of specific patient encounters. Also guests will be allowed to contribute mini-case presentations where they will report how a Web 2.0 activity changed how they managed a patient.

The blog is still in development phase. In the meantime, you are in for a treat. His upcoming blog entries are great examples demonstrating the impact of online and app-based clinical decision support tools in the ED.

Let’s welcome Tim to the blogging community!

By Michelle Lin, MD|2016-11-11T18:51:03-08:00Mar 26, 2012|Social Media & Tech|

Paucis Verbis: Kawasaki Disease

Kawasaki Disease can be easy to diagnose when you have the pediatric patient, who presents with all 5 of the classic clinical findings. What happens when you have the prerequisite fever for ≥5 days, but only 2-3 clinical criteria?

What ARE the 5 classic findings?
When do you do waitful watching?
When do you perform an echo?
When do you treat empirically?

Check out the nice flowchart below which addresses these questions. They summarize the most recent (2004) American Heart Association’s consensus group’s recommendations.

PV Card: Kawasaki Disease (AHA 2004)

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

Reference

Newburger J, Takahashi M, Gerber M, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110(17):2747-2771. [PubMed]

By Michelle Lin, MD|2021-10-10T19:08:53-07:00Mar 23, 2012|ALiEM Cards, Cardiovascular, Pediatrics|

Trick of the Trade: Pelvic speculum for peritonsillar abscess

Peritonsillar abscess drainage in the ED continues to be one of my favorite procedures to perform. There are several tricks to increase your chances for a successful aspiration. One trick involves using a curved laryngoscope to help depress the tongue AND provide a bright light source.

What if you don’t have a laryngoscope readily available?

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By Michelle Lin, MD|2019-01-28T23:36:17-08:00Mar 20, 2012|ENT, Tricks of the Trade|

Video: Khan Academy and digital whiteboards

Dr. Rob Rogers (University of Maryland) is at it again with another brilliant installment of his Medical Education Videos. This 10-minute video covers the Khan Academy and how you too can create an interactive digital whiteboard for education. He talks about Doceri ($50 single-user access) and Splashtop ($19.99 for the iPad app).

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By Michelle Lin, MD|2019-01-28T22:34:42-08:00Mar 19, 2012|Medical Education, Social Media & Tech|

Trick of the Trade: Irrigation fluid is key – but not in your eye!

High pressure irrigation of wounds is critical in reducing the rate of wound infection. There are a variety of commercial irrigation kits which include splash guards. If you are irrigating correctly and generating at least 8 PSI of pressure, some irrigation fluid should splash up and out of the wound. Be careful not to splash irrigation fluid in your eyes.

What if you don’t have a commercial irrigation setup?

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By Michelle Lin, MD|2026-06-16T16:02:49-07:00Mar 13, 2012|Tricks of the Trade|

Paucis Verbis: Continuous Infusions

I have always been envious of the residents who carry around the Continuous Infusions cheat-sheet card, which was created by the UCSF Critical Care Units as part of a campaign for Safe Medication Prescriptions. I want one! So I finally managed to wrangle one away for a few minutes and xerox copy it. Here is the abbreviated card, after paring down the list to just ED-focused medications.

PV Card: Continuous Infusions

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-10T19:14:04-07:00Mar 9, 2012|ALiEM Cards, Tox & Medications|

About Michelle Lin, MD

PV Card: Kawasaki Disease (AHA 2004)

Reference

PV Card: Continuous Infusions