The national SAEM meeting in Boston just concluded and was a success. As part of the SAEM Social Media Committee, I was encouraged to see how many people were tweeting events from the meeting. Check out the tweets with the #SAEM11 hashtag.
To view beyond the most recent 100 tweets, you can view here.
“Should I get a D-Dimer test or CT chest angiogram on my patient with atypical chest pain to rule-out a pulmonary embolism?” This is a common question asked by emergency physicians on a routine basis.
Here are 3 clinical prediction rules: PERC, Wells, and Simplified Geneva Score. Personally, I’ve never used the Geneva Score, but it’s worth looking at.
These rules should be used with caution, because none of these scoring protocols are perfect. For instance, in a recent publication in the Journal of Thrombosis and Haemostasis, the authors found that the PERC rule does not actually safely exclude PEs.1 Big bummer for us clinicians.
Go to ALiEM (PV) Cards for more resources.
Thanks to Dr. Kit Tainter (Mount Sinai PGY-4 EM resident) for coming up with the idea for this card!
I have heard of using tea bags under your eyes to reduce puffiness, but to combat odors in the ED?
In my growing list of “Tricks of the Trade” tips for protecting your olfactory nerves (Antacid booties for toxic sock syndrome, aerosolized orange juice, abscess drainage using suction), I got a clinical gem from Dr. James Juarez (Rogue Valley Medical Center in Ashland, OR) after my recent Tricks of the Trade talk at High Risk EM in San Francisco.
“To be or not to be?”
What could be more strange on a medical school curriculum than a theater training course? The authors of this study in Medical Humanities innovatively designed a 1-week elective course to help medical students at Mayo Medical School to improve their case presentation skills in partnership with the Guthrie Theater.
In this pilot course, seven medical students (six 1st year students, one 4th year student) participated. The learning objectives were:
Students were evaluated for the following competencies:
Eleven sessions, over 25 hours, comprised of the following topics:
Survey responses uniformly found that students valued this creative, non-traditional approach to learning about interpersonal communications and oral presentations. The art of focused storytelling to an audience is exactly what physicians do every day when presenting clinical cases.
Reference
Hammer RR, et al. Telling the Patient’s Story: using theatre training to improve case presentation skills. Medical humanities. 2011, 37(1), 18-22. PMID: 21593246
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The classic prior teaching for the treatment of diverticulitis includes:
Do ALL patients need to be admitted? There is some early literature suggesting that there is a small sub-population who fare well with outpatient treatment.
This article from Annals of EM in the “Best Available Evidence” series summarizes the existing literature well.
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.
This paper only provides guidelines, based on the limited evidence out there. Still use your common sense. For instance, I’d still admit patients who are elderly (>80 years old) or have evidence of any perforation on CT. If on the fence, admit the patient.
Still it’s nice to see that the treatment of uncomplicated diverticulitis on an outpatient basis has some supporting literature.
A patient presents with a swollen finger after falling and fracturing it. The patient is more distraught by the fact that she can’t get the ring off her finger. She implores you not to cut the ring off.
There are textbook chapters written about tightly wrapping the digit with string from distal-to-proximal and sliding the string under the ring. Theoretically, the provider can pull and unwind the proximal end of the string to gradually coax the ring over the coils of string.
I have personally found little luck with this maneuver.
They all died from an aortic dissection. We commonly consider this diagnosis for Emergency Department patients presenting with severe chest pain. There is an International Registry on Aortic Dissection which published a retrospective, descriptive study of 464 patients with dissections.
I find this list helpful, because it illustrates the fact that the classic signs and symptoms aren’t actually very common. Here are some scary examples:
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.