Paucis Verbis: Post-exposure prophylaxis (non-occupational)

You know how chief complaints present to the ED in multiples? In one week, I had several cases where patients were asking for post-exposure prophylaxis treatment NOT in the content of a sexual assault. I haven’t had to manage such cases in a long time and so needed to look up the recent guidelines from the CDC.¹

The trick is not to forget about all the co-existing problems and infections beyond just HIV. Specifically, don’t forget about gonorrhea, chlamydia, and trichomonas.

PV Card: Post-Exposure Prophylaxis for Non-Occupational Contact

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Adapted from [2]
Go to ALiEM (PV) Cards for more resources.

References

STD Treatment. Centers for Disease Control. http://www.cdc.gov/std/treatment/default.htm.
Landovitz RJ, Currier JS. Postexposure Prophylaxis for HIV Infection. New England Journal of Medicine. 2009;361(18):1768-1775. doi: 10.1056/nejmcp0904189

By Michelle Lin, MD|2026-06-16T16:03:12-07:00Apr 1, 2011|ALiEM Cards, Infectious Disease|

What’s your perfect idea for a medical app?

The American Medical Association (AMA) is harnassing the innovative power of the people in its “AMA App Challenge”. What do you think would be the perfect app for medical students, residents, and/or practicing physicians in their day-to-day life?

This challenge is the perfect opportunity for all those with great app ideas but are too busy (or lazy) to do the technical, legal, and business groundwork to make the idea a reality. The down side is that once you submit the idea, AMA has full proprietary ownership of it.

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By Michelle Lin, MD|2019-01-28T22:57:41-08:00Mar 31, 2011|Social Media & Tech|

Trick of the Trade: Steristrip-suture combo for thin skin lacerations

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?

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By Michelle Lin, MD|2019-11-29T18:57:44-08:00Mar 30, 2011|Geriatrics, Trauma, Tricks of the Trade|

Nancy Duarte at TedxEast: The anatomy of a great speech

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:

You Can Change The World

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By Michelle Lin, MD|2019-01-28T22:57:54-08:00Mar 29, 2011|Medical Education|

Article Review: Role of instructional technologies in medical education

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.

Trends

Explosion of new information: It has been postulated that the world’s body of knowledge will double every 35 days by 2015. We are in an age of information explosion. Physicians will have to be able to process an ongoing onslaught of information throughout their career. Learning how to sustain lifelong learning will be critical.
Digitization of all information: Medical records are slowly transitioning to an all-electronic format. Also in the age of Web 2.0, much of the digital content in health care are posted by the learners. Medical schools and residency programs will have to shift their approach to teaching, disseminating, filtering, and supporting learning in this digital age.
New generation of learners: Learners in medical schools are primarily “digital natives”. They have grown up with primarily digital textbooks and references. They have grown up with Facebook and Google. In contrast, educators are usually “digital settlers” — not “born digital” but now “live digital”.
Emergence of new instructional technologies: In the Web 2.0 age, there are a myriad of online tools such as blogs, wikis, podcasts, and virtual learning environments.
Accelerating change: Computers will increasingly play a greater role in our everyday lives. I imagine something like the Minority Report movie. The future is almost here.

Recommendations

Use technology to support learning: Technology shouldn’t replace face-to-face learning but rather supplement areas which are better served using technology. Technology definitely helps with geographically distant learning groups, teaching deliberate practice using simulation, and individualizing learning plans.
Focus on the fundamentals: Keep your eye on the prize. Don’t be tempted to use the new technologies for the sake of being current. First and foremost, focus on learner needs and the course objectives.
Allocate a variety of resources: Faculty should be taught how to effectively use instructional technologies in faculty development workshops. Furthermore, “e-learning specialists” should be available to help faculty create effective courses. These specialists include Web designers, videographers, and e-learning management system experts.
Support and recognize faculty as they adopt new technologies: Institutional grants should be created to support faculty who want to adopt new instructional technologies. Furthermore, University promotion committees should value e-learning teaching modalities as academic scholarship. I wholeheartedly support this second statement– my blog is still considered a “hobby” rather an academic pursuit. Good thing I love doing this.
Foster collaboration: We, as educators, need to share our ideas and resources nationally and internationally. Examples include the Health Education Assets Library (HEAL), MedEdPORTAL.

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 .

By Michelle Lin, MD|2016-11-11T18:58:12-08:00Mar 28, 2011|Education Articles, Medical Education, Social Media & Tech|

Paucis Verbis: Chemical sedation for severe agitation

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.

PV Card: Chemical Sedation for Agitation

<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

Nobay F, Simon BC, Levitt MA, Dresden GM. A Prospective, Double-blind, Randomized Trial of Midazolam versus Haloperidol versus Lorazepam in the Chemical Restraint of Violent and Severely Agitated Patients. Academic Emergency Medicine. 2004;11(7):744-749. doi: 10.1197/j.aem.2003.06.015

By Michelle Lin, MD|2021-10-16T19:23:38-07:00Mar 25, 2011|ALiEM Cards, Tox & Medications|

Trick of the Trade: Benzoin for opening traumatic, swollen eyelids

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.