Paucis Verbis: Right and posterior ECG leads

A standard 12-lead ECG can be very telling for patients with chest pain or shortness of breath. A right ventricular (RV) and posterior wall infarct, however, can present very subtly. You can obtain special right-sided (V1R-V6R) and posterior leads (V7-V9), if you are concerned. What are the indications for obtaining right-sided and posterior ECG leads?

Go to the ALiEM Cards for more resources.

Addendum 3/11/11:

Right sided ECG leads (V1R-V6R) are positioned in a mirror image fashion from the standard 12-lead precordial leads.

Posterior ECG leads (V7-V9) are applied by moving V4-V6 in the posterior positions.

By Michelle Lin, MD|2021-10-16T19:28:52-07:00Mar 11, 2011|ALiEM Cards, ECG|

Trick of the Trade: Heat it up!

What is it about heat that makes everything feel better? Fireplace, hot tub, heat packs, electric blankets, and hot chocolate have got to be the best inventions EVER.

How can we apply this in Medicine?

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By Michelle Lin, MD|2026-06-16T16:03:14-07:00Mar 9, 2011|Tricks of the Trade|

Finding the right journal for your manuscript

When writing a manuscript, how do you choose what journal to submit to? You should factor in the journal’s impact factor and your manuscript content.

At the recent CORD Academic Assembly meeting, I learned of a website which helps you decide your journal.

JANE: Journal/Author Name Estimator

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By Michelle Lin, MD|2019-01-28T23:04:10-08:00Mar 8, 2011|Medical Education|

Trick of the Trade: Website resource on HIV medications

At our department’s first annual UCSF High Risk Hawaii Conference 2 weeks ago, Dr. Rachel Chin taught about complications from all of the HIV drugs on the market now. It’s a virtual alphabet soup: EFV, TDF, FTC, oh my. How do you keep track of them all?

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By Michelle Lin, MD|2019-01-28T23:04:30-08:00Mar 2, 2011|Infectious Disease, Social Media & Tech, Tricks of the Trade|

Paucis Verbis: Pneumonia risk stratification tools

Pneumonia is a common cause for ED visits. How do you decide on whether the patient can be managed as an outpatient or inpatient? To supplement your clinical judgment, many clinicians use the Pneumonia Severity Index (PSI) score.

Have you heard of CURB-65, supported by the British Thoracic Society? What about SMART-COP, which is meant to help you predict if your patient will need Intensive Respiratory or Vasopressor Support (IRVS)?

PV Card: Risk Stratification Scoring Tools in Pneumonia

Go to the ALiEM Cards for more resources.

By Michelle Lin, MD|2021-10-16T19:31:04-07:00Feb 25, 2011|ALiEM Cards, Pulmonary|

Article Review: Professionalism of physicians on Twitter

In a Research Letter in JAMA, Dr. Chretien et al describe the profile of physicians in the Twitter universe, specifically focusing on professionalism.

Inclusion criteria:

Self identified physician
At least 500 followers during May 1-31, 2010 (Whew, I only have 309 followers.)
English tweets
Posted a tweet within last 6 months

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By Michelle Lin, MD|2016-11-11T18:59:20-08:00Feb 21, 2011|Education Articles, Social Media & Tech|

Paucis Verbis: Assessing patients with suicidality in the ED

Dr. Rob Orman emailed me last week about creating a pocket card on Suicide Risk Stratification. In many community ED’s, risk assessment is done by the emergency physician. I’m lucky where I work, because we have a 24/7 psychiatric ED, which consults on suicidal patients in the “medical ED”.

In the end, assessment is primarily based on physician judgment, because there’s no great clinical decision tool, rules, or scores to assess risk. Rob has created his own mnemonic to help you ask the right questions in assessing a suicidal patient. This is a sneak peek into a larger article that Rob is planning to unleash on the world on suicide assessment. Based on his review of the literature and own clinical experience, the mnemonic is: TRAAPPED SILO SAFE.

TRAAPPED SILO

“Risk factors” which increase a patient’s risk for committing suicide in the near future.

SAFE

“Protective factors”which decrease a patient’s risk for committing suicide in the near future.

PV Card: Risk Stratification of Suicide

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-16T19:32:00-07:00Feb 18, 2011|ALiEM Cards, Psychiatry|

About Michelle Lin, MD

Addendum 3/11/11:

PV Card: Risk Stratification Scoring Tools in Pneumonia

TRAAPPED SILO

SAFE

PV Card: Risk Stratification of Suicide