I rarely access the femoral vein for central venous catheterization… except in medical or trauma resuscitations. Oftentimes in these resuscitations, there are too many people near the IJ or subclavian vein site. People are intubating, performing CPR, trying to get peripheral vein access, etc.
Reflective journals and electronic portfolios are becoming increasingly popular within undergraduate and graduate medical education. I’m starting to be a believer in this learning approach, which teaches learners about professional development and life-long learning principles. Academic Medicine just published a great qualitative paper proposing a conceptual model for reflection.
The Society of Academic Emergency Medicine’s (SAEM) annual meeting starts this week. Instead of my regular posts, I thought I’d try using the Twitter widget to post real-time, first-hand accounts and photos from the conference.
SAEM is a very dynamic and productive conference, where academicians in Emergency Medicine meet to pow-wow about the future of our specialty.
There are some things in life which I just can’t memorize and dermatomal/myotomal maps are one of them. Weird cases of peripheral neurologic symptoms have presented to the ED in the setting of trauma and no trauma. So purely for selfish reasons, I’m making my own map to have on file.
This installment of the Paucis Verbis (In a Few Words) e-card series reviews Sensory and Motor Function Testing by Levels.
Testing Sensory Function by Level
Testing Motor Function by Level
- C1-C4 Spontaneous breathing
- C5 Shoulder abduction (deltoid)
- C6 Wrist extension (carpi radialis longus and brevis)
- C7 Elbow extension (triceps)
- C8 Finger flexion (flexor digitorum superficialis/profundis, lumbricals)
- T1 Finger adduction & abduction (dorsal/palmar interossei, abductor digiti quinti)
- T1-T12 Intercostal and abdominal muscles
- T12-L3 Hip flexion (iliopsoas)
- L2-L4 Hip flexion, knee extension (quadriceps), hip adduction
- L4 Ankle dorsiflexion and inversion (anterior tibialis)
- L5 Big toe extension (ext hallucis longus), heel walk (ext digitorum), hip abduction (gluteus medius)
- S1 Ankle plantarflexion and eversion (peroneus longus), toe walk (peroneus brevis), hip extension (gluteus maximus)
- S2-S4 Rectal sphincter tone
Go to the ALiEM Cards site for more resources.
Trick of the Trade: Endotracheal tube lubrication
Occasionally the endotracheal tube may become “caught up” along the epiglottis. Because it is difficult to predict when this may happen, pre-lubricate the endotracheal tube cuff and tip with a thin layer of water-soluble lubricant, such as K-Y jelly. This lubricant can also minimize the degree of surface trauma to the trachea and tracheal rings as the tube passes the vocal cords.
Often times, I get called to triage to help decide whether a patient should be sent to Radiology for an initial x-ray after injuring their knee, ankle, and/or foot. After teaching one of the nurses about the Ottawa rules, she taped a list of these rules on the triage wall.
This installment of the Paucis Verbis (In a Few Words) e-card series reviews Ottawa Knee, Ankle, and Foot Rules.
I recently re-read a book “Made to Stick” by Chip Heath and Dan Heath which discusses why some ideas stick and others are completely forgettable. The concepts discussed have helped me design lectures.
Here’s something that I have incorporated into my talks: Memorable ideas share common attributes, which can be summarized by the acronym SUCCESs.