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.
- Is the wound suspicious for child abuse?
- Procedural sedation versus local anesthesia of the wound
- Staples versus hair apposition technique (HAT trick) for wound closure
This trick of the trade pearl addresses the stapling technique for scalp laceration repair. Perhaps the child’s hair is too short for the HAT trick.
I recently came across a new means of online teaching and information delivery called sketchcasting. The premise isn’t new. It combines a podcast (someone speaking) with visuals (images). In sketchcasting, the images are instead someone drawing on a virtual whiteboard in real-time to convey information.
I recently found a sketchcast with stop-motion and speed-up effects, which really made the presentation dynamic and super-engaging. This sketchcast by Dan Pink (Author of “Drive: The Surprising Truth About What Motivates Us”) was created by the Royal Society for the Arts, Manufactures and Commerce (RSA).
In the workup of monoarticular arthritis, the question that emergency physicians constantly struggle over is whether the patient has a nongonococcal septic arthritis. This joint infection alarmingly damages and erodes cartilage within only a few days.
This installment of the Paucis Verbis (In a Few Words) e-card series reviews the JAMA Rational Clinical Examination article which asks “Does this patient have septic arthritis?” Pooled sensitivities and likelihood ratios were calculated. These statistics are always helpful when trying to figure out the patients probability of having a septic joint.