Have you heard of the RIME method of evaluating learners on their clinical rotation? Dr. Lou Pangaro (Vice Chair for Educational Programs in the Dept of Medicine at the Uniformed Services University) published a landmark article in 1999 on his simple yet effective approach in evaluating medical students and residents. I had the pleasure of briefly meeting Dr. Pangaro when he gave CDEM’s keynote speech in 2008.
A paracentesis procedure is often performed in the Emergency Department to rule a patient out for spontaneous bacterial peritonitis (SBP).
- Do you check coagulation studies before performing the procedure?
- How comfortable do you feel that the patient has SBP with an ascites WBC > 500 cells/microliter or ascites PMN > 250 cells/microliter?
The blog is already one year old! What started initially as a little educational experiment has now evolved into a potentially long-term endeavor. It was initially built as a sort of personal journal of what I’ve learned and read about in the field of academic emergency medicine and educational technologies. Now I’ve it focuses on academics, clinical emergency medicine (Paucis Verbis cards), faculty and resident development, and technologies.
Small pneumothoraces can be difficult to detect on chest xrays. Overlying ribs, other bony structures, and soft tissue can obscure subtle findings. For a patient at risk for a small pneumothorax, you can use your digital radiology PACS system to improve your ability to spot them.
In 2009, ACGME has launched a new journal focused on graduate medical education, called the Journal of Graduate Medical Education (JGME). For those of you with education manuscripts in need of a “home”, consider this peer-reviewed journal. It publishes quarterly.
An article in Critical Care Medicine examines the impact of family presence on the ED personnel’s actions, rather than the impact on the families themselves. Second and third-year EM residents were randomized into paired teams in simulation exercises. All resuscitations involved a cardiac arrest patient. Each team was exposed to one of three types of resuscitation groups:
- No family witness
- Non-obstructive family witness (quiet person) – quiet crying and conversation with social worker
- Overtly grieving family witness – loud crying, attempts to hug patient during resuscitation
Appendicitis is a common presentation in the Emergency Department. Dilemmas arise when deciding whether to image patients with equivocal symptoms and WBC lab results. Given the risk of ionizing radiation with CT scans, we should ideally minimize the number of CT scans ordered in these patients without mistakenly sending patients home with an early appendicitis. A perforated appendix places the patient at risk for bowel obstruction, infertility (in women), and sepsis.