About Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco

Paucis Verbis: Blunt cerebrovascular injuries

In the setting of blunt trauma, it is easily to overlook a patient’s risk for blunt cerebrovascular injuries (BCVI). These are injuries to the carotid and vertebral arteries. Often they are asymptomatic with the initial injury, but the goal is to detect them before they develop a delayed stroke.

Who are at risk for these injuries?
What kind of imaging should I order to rule these injuries out?
Do I really treat these patients with antithrombotic agents even in the setting of trauma to reduce the incidence of CVA?

FYI: A simple seat-belt sign along the neck does not warrant a CT angiogram. Patients with higher risk findings such as significant pain, tenderness, swelling, and/or a bruit probably need imaging.

PV Card: Imaging for Blunt Cerebrovascular Injuries

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

References

Burlew C, Biffl W. Imaging for blunt carotid and vertebral artery injuries. Surg Clin North Am. 2011;91(1):217-231. [PubMed]
Paulus E, Fabian T, Savage S, et al. Blunt cerebrovascular injury screening with 64-channel multidetector computed tomography: more slices finally cut it. J Trauma Acute Care Surg. 2014;76(2):279-83; discussion 284-5. [PubMed]
Bruns B, Tesoriero R, Kufera J, et al. Blunt cerebrovascular injury screening guidelines: what are we willing to miss? J Trauma Acute Care Surg. 2014;76(3):691-695. [PubMed]

By Michelle Lin, MD|2021-10-13T08:38:34-07:00Jul 1, 2011|ALiEM Cards, Cardiovascular, Radiology, Trauma|

An intern’s perspective: Doing well on your EM clerkship

It’s that time of year again. When medical students interested in EM are stressing over doing well on their EM rotation.

Here’s a very insightful guest post from Dr. James Connolly, who is a new PGY-1 resident at Hahnemann Hospital in Philadelphia. I’ll write my personal top-10 list next week, from the perspective of a faculty member.

Many MS4 interested in emergency medicine will be starting their EM Sub-I’s in the next few weeks and are naturally wondering what to expect, and how they can be successful, both in terms of getting a strong letter of recommendation, and all while still having a fun and enjoyable rotation. With that in mind, I’d like to present a unique “Top Ten” list, written with the aim of helping the student succeed on his or her upcoming rotation. The list is my own, based on my experiences during three EM rotations last year as a medical student. I’ve also asked a few of my fellow interns for their input on the list, so the list really reflects thoughts of a handful of people who recently successfully matched into emergency medicine.

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By Michelle Lin, MD|2019-01-28T22:42:19-08:00Jun 30, 2011|Medical Education|

You are doing a shift in the pediatric ED and you are evaluating a kid with a small bead in her ear. There are a ton different approaches you can use (eg. tissue adhesive glue on a q-tip stick). If the bead is in too deep, blindly trying to adhere the foreign body to the glue is a bit risky. Sometimes applying gentle irrigation might not be enough to wash out the bead. You want to avoid irrigation if you worry about a tympanic membrane rupture.

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By Michelle Lin, MD|2019-01-28T22:42:38-08:00Jun 29, 2011|Tricks of the Trade|

Article review: Carnegie’s vision for medical education

In 2010, the Carnegie Foundation for the Advancement of Teaching published recommendations for the future reform of medical education. This same Carnegie Foundation had also commissioned and published the landmark 1910 Flexner report ¹ on medical education, exactly 100 hears prior.

Here is a summary of the four major recommendations:

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By Michelle Lin, MD|2019-01-28T22:43:03-08:00Jun 27, 2011|Education Articles, Medical Education|

Paucis Verbis: Clostridium Difficile

I just finished taking the 2011 LLSA exam to remain eligible for recertification. The only good thing about this test is that it gives me interesting topics for my Paucis Verbis cards.

Here’s a card on a disease process that is becoming increasingly prevalent — Clostridium difficile. This is a summary based on the 2010 guidelines by Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA).

Because healthcare workers are often the culprit for transmitting C. difficile to other patients, be sure you wash your hands with soap and water really well. Wear gloves. Be aware that alcohol-based hand rubs (eg. hand sanitizers) are ineffective in killing C. difficile spores.

PV Card: Clostridium Difficile Infection

<span data-mce-type="bookmark" style="display: inline-block; width: 0px; overflow: hidden; line-height: 0;" class="mce_SELRES_start"></span>
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

Cohen S, Gerding D, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31(5):431-455. [PubMed]

By Michelle Lin, MD|2021-10-13T08:41:07-07:00Jun 24, 2011|ALiEM Cards, Gastrointestinal, Infectious Disease|

Trick of the Trade: Cunningham maneuver for shoulder dislocation

We commonly see patients with shoulder dislocations in the Emergency Department. There are a myriad of approaches in relocating the joint, which includes scapular rotation, Snowbird, and Kocher maneuvers.

I recently stumbled upon the Cunningham technique after hearing about it from Dr. Graham Walker (of MDCalc fame) on TheCentralLine.org.

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By Michelle Lin, MD|2019-01-28T22:43:28-08:00Jun 22, 2011|Orthopedic, Tricks of the Trade|

Article review: Professionalism in the ED through the eyes of medical students

Teaching professionalism in a formal curriculum is so much different than demonstrating professionalism in the Emergency Department. So much of what students and residents learn about professionalism are from observed behaviors of the attending physicians — that is, the hidden curriculum.

In a qualitative study assessing medical student reflection essays during an EM clerkship, the authors (my friends Dr. Sally Santen and Dr. Robin Hemphill) found some startling results. The instructions to the medical students were to “think about an aspect of professionalism that has troubled you this month. Write a minimum of one half-page reflection describing what was concerning and how you might handle it.”

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By Michelle Lin, MD|2016-11-11T18:52:55-08:00Jun 20, 2011|Education Articles, Medical Education|

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