Lacerations of elderly patients or chronic corticosteroid users can be a challenge because they often have very thin skin. Sutures can tear through the fragile skin. Tissue adhesives may not adequately close the typically irregularly-edged laceration.
How do you repair these lacerations?
Do you just slap a band-aid on it?
Nancy Duarte, the author of “Resonate — Present Visual Stories that Transform Audiences” and CEO of Duarte Design, recently gave a talk at TedxEast. The title was:
A conference called “A 2020 Vision of Faculty Development Across the Medical Education Continuum” was held at Baylor College of Medicine in 2010. At this conference, experts convened to discuss the changing role of technologies in medical education.
Their conclusions were summarized in this Academic Medicine article, which discusses 5 trends and 5 recommendations.
Reference
Robin BR, McNeil SG, Cook DA, Agarwal KL, Singhal GR. Preparing for the Changing Role of Instructional Technologies in Medical Education. Acad Med. 2011 – in early press. PMID: 21346506.
Haldol, Ativan, and Versed… oh my.
In the Emergency Department, some patients present very acutely and aggressively agitated. This is usually the result of illicit drug use or a schizophrenic who hasn’t been taking medications (or both!). Fortunately, we have an arsenal of medications to help sedate the patient.
One study looked to answer the question of what single IM sedation agent is most effective, as measured by the shortest time to sedation and time to arousal.
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.
Patients who sustain facial trauma often have swollen eyelids. They may be so swollen that it is impossible to pull back the eyelids for an ocular exam. You use one of our “Tricks of the Trade”ideas and attempt to “roll” the upper eyelid using the Q-tip trick (above).
Fresh blood on the face, however, makes the Q-tip a little slippery along the upper eyelid, preventing an adequate view of the eye itself.
I think there is no better or more rewarding job than being an educator, especially in the field of Medicine.
There are, however, significant financial, societal, curricular, and environmental barriers which prevent optimally effective teaching in Medicine. In a commentary piece in Academic Medicine, the authors review the barriers and some forward-thinking recommendations for our leaders in medical academia. While the focus of the article is on undergraduate medical education, many concepts apply to graduate medical education as well.
(more…)
You have a 40 year-old man who presents to the ED for persistent right upper quadrant abdominal pain for 12 hours after eating a fatty meal. He has no fevers, nausea, flank pain, or dysuria. His physical exam shows no fever and only moderate tenderness in the RUQ without guarding. He has a Murphy’s sign which is improved after a total of 8 mg of IV morphine. His laboratory results, which include a WBC, liver function tests, lipase, and urinalysis, are normal.
Can you safely say that the patient doesn’t have cholecystitis? Can you discharge him for outpatient ultrasonography to assess for symptomatic cholelithiasis?
As bedside ultrasonography becomes more of a staple in Emergency Departments, it is easy to just perform the ultrasound yourself if such a patient presents. If you do not have an ED ultrasound available, however, you need to send this patient for a formal ultrasound because he is still very much at risk for cholecystitis despite having unremarkable lab tests and no fever.
JAMA published a meta-analysis of 17 studies on the test characteristics for cholecystitis. I found it odd that they defined a fever as temperature >35 Celsius. The best performing characteristic was a Murphy’s sign, although the positive likelihood ratio (LR) slightly crossed 1.0 (0.8-8.6).
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.