About Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco

Paucis Verbis: Sgarbossa’s Criteria with LBBB

It is difficult to determine if a patient with a left bundle branch block (LBBB) has an acute myocardial infarction (AMI) because ST segments are “appropriately discordant” with the terminal portion of the QRS. That means if the QRS complex is negative (or downgoing), the ST segment normally will be positive (or elevated). Similarly if the QRS complex is positive (or upgoing), the ST segment will be negative (or depressed).

PV Card: Sgarbossa’s Criteria

In 1996, Sgarbossa et al looked through the GUSTO-1 trial patients with LBBB and AMI. They derived 3 criteria which may help diagnose the “hidden” AMI. The criteria are:

1. ST elevation ≥ 1 mm concordant with QRS complex (most predictive of AMI of the 3 criteria)
2. ST depression ≥ 1 mm in lead V1, V2, or V3
3. ST elevation ≥ 5 mm where discordant with QRS complex

Use these criteria with caution though. None of these criteria are perfect. They are to help you risk-stratify. For instance, criteria #3 (ST elevation ≥ 5 mm) can exist in asymptomatic patients with LBBB because of concurrent left ventricular hypertrophy and high voltages.

Thanks to Tom Bouthillet at ems12lead.com for the useful illustration above.

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-17T09:25:38-07:00Nov 5, 2010|ALiEM Cards, Cardiovascular, ECG|

Residency interview season: Pitfalls

I often get asked by my advisees: “In my residency interview, what should I talk about or do to make myself more competitive?”

To help you demystify the interview process, I wanted to share with you some insights. Overall, the interview day itself helps the program put a person and personality with your online ERAS application. Similarly, you quickly get a sense of the program’s personality. In EM, the residency interview day is generally pretty laid back. Not too many crazy questions. Programs just want to get to know you. Both you and the program should be asking each other– Is this a good fit?

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By Michelle Lin, MD|2016-11-11T19:00:21-08:00Nov 4, 2010|Medical Education|

Trick of the Trade: Legg Maneuever for shoulder dislocation

There are many ways to relocate a shoulder dislocation. Most of these ways require procedural sedation. What if the risks of procedural sedation outweigh the risks? What alternative maneuver can you try, which only requires parenteral pain medications +/- an intra-articular lidocaine?

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By Michelle Lin, MD|2016-11-11T19:00:23-08:00Nov 3, 2010|Orthopedic, Tricks of the Trade|

New kid on the block: Univ of Washington EM residency

How awesome would it be if there were EM residency programs at the University of Washington and UCSF-SF General Hospital?!

This has been the question for decades. In 2006, I had the pleasure of seeing the UCSF-SFGH program become a reality. And now it’s the University of Washington’s turn. It is close to becoming a reality. It is really one of the last powerhouse institutions which does not have an EM residency program.

The Univ of Washington EM residency’s Program Director is helmed by my superstar friend, Dr. Fiona Gallahue, and will be a 4-year program. The ACGME (accrediting organization) has already site-visited the program. Short of an unforeseen snafu, I can’t imagine that it won’t be approved for a start year of 2011-12. The program will find out the official answer on February 14, 2011.

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By Michelle Lin, MD|2017-03-05T14:18:35-08:00Nov 2, 2010|Medical Education|

Residency interview season is quickly approaching!

Unique to the field of EM, letters of recommendations from EM faculty are written on a standardized form. The Standardized Letter of Recommendation (SLOR), downloadable from the CORD website, documents information about the student’s performance in the EM clerkship, qualifications, and global assessment. At the end, the letter writer can provide free-text written comments.

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By Michelle Lin, MD|2019-01-28T23:20:54-08:00Nov 1, 2010|Education Articles, Medical Education|

Paucis Verbis card: Algorithm for suspected pertussis in pediatrics

To treat for pertussis or not?

In the setting of the current pertussis epidemic in California, each kid with a cough sparks constant debate about whether to treat with azithromycin or not. Finally, thanks to my friends Dr. Andi Marmor and Dr. Shon Agarwal Jain (UCSF Pediatrics faculty), there’s a great algorithm to help you answer the question. I have found this algorithm extremely helpful.

You basically start by risk-stratifying by age and pertussis immunization status. For instance, if the patient is 6 months of age AND unimmunized), then follow the algorithm listed as “High Risk for Pertussis”.

PV Card: Suspected Pertussis in Pediatric Patients

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-17T09:28:20-07:00Oct 29, 2010|ALiEM Cards, Infectious Disease, Pediatrics|

The Society for Academic Emergency Medicine (SAEM) holds its annual meeting at various U.S. metropolitan cities. This year, it is going to be at Boston in June 1-5, 2011.

It is a terrific conference for medical students and residents interested in EM academia. To help coordinate the huge meeting, the SAEM Program Committee is looking for 15 enthusiastic medical students to serve as volunteers.
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By Michelle Lin, MD|2016-11-11T18:43:23-08:00Oct 28, 2010|Medical Education|

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