A few years ago, Dr. Esther Choo and I created a fun 15-minute instructional video on called Giving Effective Feedback: Beyond “Great Job”. We had a blast recording sample feedback scenarios with our faculty and medical students. For every 1 minute of published footage, there were at least 9 minutes of bloopers and laughter! We definitely should keep our day job.
In academia, faculty are expected to do it all– clinical care, bedside teaching, formal didactics, scholarly work, and administrative projects. Asking for protected time, or release time from clinical work, from your department chair is often a difficult negotiation process, especially for junior faculty.
Fresh out of residency and fellowship training, junior faculty are just excited to get started as an academic faculty member. A downpour of exciting opportunities descends upon you, and you just can’t say no to them! A year later passes, and you realize that you are overwhelmed.
How do you workup adult patients who present with a new-onset seizure and now neurologically back to normal?
There unfortunately is very little recent literature about the best workup approach. In 1994, the American College of Emergency Physicians (ACEP) published a Clinical Policy based on expert consensus. The EM Clinics of North America series also just published a review on the topic. The bottom-line is that there are two types of workup approaches.
For the uncomplicated cases (age less than 40 years, afebrile, no comorbidities, no neurologic deficits), the workup is fairly minimal, which includes:
Otherwise, the more complex cases require a more extensive workup, which may include a lumbar puncture in the setting of a fever, severe headache, immunocompromised status, or persistent altered mental status.
Be sure you obtain a head CT for patients who you think are presenting with a simple new-onset, alcohol-withdrawal seizure. One study showed that 6.2% of these patients actually have a significant lesion on CT (eg. bleed, mass).
Adapted from [1, 2]
Go to ALiEM (PV) Cards for more resources.
So, I volunteered to give a talk for the UCSF Office of Graduate Medical Education WAAAAY back in early 2010 on “There’s an App for That: Key Smart Phone Applications for Surviving Residency“. Somehow the lecture date has snuck up on me and it’s next Tuesday! I thought it was a small gathering, but it turns out it’s not. Plus, I keep getting school-wide emails reminding all the residents and fellows to attending!
The ever-creative and ambitious masterminds at Life in the Fast Lane has just launched a new feature called LITFL Review. This weekly review will highlight all-things EM in the social media world. Do they ever sleep over there in Australia?! Do they somehow have 25 hours in their day?
Suturing is a common procedure performed in the ED, but we too often forget about the nuances of different suture materials. We get set in our practice patterns. This changed when our ED got the fast-absorbing gut suture for surface wounds, especially for pediatric patients. This makes a return visit for suture removal unnecessary because they quickly become absorbed over time. Increasingly, I have observed plastics surgeons using these for surface wound closure of the face and hands.
Has anyone else used absorbable sutures on the skin for wound closure?
With this new suture material in my armamentarium, I thought it’d be helpful to review suture types and suture removal times for non-absorbable sutures.
Go to ALiEM (PV) Cards for more resources.
Contact lens wearers are familiar with the phenomenon of the wandering lens. What should you do if you can’t visualize the contact lens of a patient, who presents with a “lost contact lens” in the eye? You have the patient look in all directions and you evert the eyelid, but still no contact lens can be found. The patient swears that it’s there because of the painful foreign-body sensation.