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About Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
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New favorite blog: Wishful thinking in medical education

Wishful Thinking in Medical Education

I recently came upon this great blog by Dr. Anne Marie Cunningham, a general practitioner and Clinical Lecturer at Wales, UK. She has some really insightful posts about education, its future, and the use of new technologies. This blog has been in existence since 2008. Just as interesting are the tons of comments that she gets from a spectrum of readers. Check it out!

She is also extremely active on Twitter with over 2,000 followers (@amcunningham).

 
By |2016-11-11T18:41:00-08:00Sep 7, 2010|Medical Education, Social Media & Tech|
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Article Review: Student documentation in the chart

MedicalRecord

Do you have medical students rotating in your Emergency Department? Are they allowed to document in the medical record?

Charting in the medical record is the cornerstone of clinical communication. You document your findings, your clinical reasoning, and management plan. The medical record allows communication amongst providers. Chart documentation is a crucial skill that every medical student should know, as stated by the Association of American Medical Colleges (AAMC).

(more…)

By |2016-11-11T19:00:30-08:00Sep 6, 2010|Education Articles, Medical Education|
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Paucis Verbis card: Pertussis

Pertussis Organism

Is your Emergency Department administering Tdap immunization boosters instead of dT boosters? Patients with wounds are getting updated not only for tetanus and diphtheria, but also now for pertussis.

Apparently there has been sharp rise in the national incidence of pertussis (Bordetella pertussis shown in image) in 2010. The infection has been documented in both infants (underimmunized less than 3 months old) and adolescents/adults (loss of immunity after 10 years). In fact, the CDC has issued an epidemic warning in California.

How do you diagnose pertussis ? What are the classic symptoms? Better yet, how do you rule-it out clinically?

You won’t like the answer. It often presents like the common cold and clinical symptoms are minimally helpful in making the diagnosis. So, according to the American Academy of Pediatrics, you should treat anyone under the age of 3 months in whom you suspect pertussis. Complications from pertussis in infants include apnea, seizures, secondary pneumonia, and death. That means any with an innocent cough should be treated with azithromycin!

The following is a meta-analysis article from JAMA on diagnosing pertussis in adolescents and adults.

PV Card: Pertussis


Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

  1. Cornia P, Hersh A, Lipsky B, Newman T, Gonzales R. Does this coughing adolescent or adult patient have pertussis? JAMA. 2010;304(8):890-896. [PubMed]
By |2021-10-18T10:07:39-07:00Sep 3, 2010|ALiEM Cards, Infectious Disease, Pulmonary|
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Trick of the Trade: "Pour some sugar on me" | Reducing a rectal prolapse


Rectal prolapse sugar for edema reductionRectal prolapses are typically caused by weakened rectal muscles, continued straining, stresses during childbirth, weakened ligaments, or neurological deficits.

How do you fix them? You can attempt manual reduction of the prolapse by using direct pressure. On the other extreme, corrective surgery can be performed from either an abdominal or perineal approach.

Trick of the Trade: Pour some sugar on it.

Def Leppard may have been right. Rectal prolapses often are associated with quite a bit of rectal mucosal edema. Sprinkle granulated sugar onto the area. Wait 15 minutes. The sugar reduces the edema by osmotically drawing out the fluid. The prolapse often reduces spontaneously or with gentle manual pressure.

 

References

  1. Ramanujam PS, Venkatesh KS. Management of acute incarcerated rectal prolapse. Dis Colon Rectum. Dec 1992;35(12):1154-6.
  2. Coburn WM III, Russell MA, Hofstetter WL. Sucrose as an aid to manual reduction of incarcerated rectal prolapse. Ann Emerg Med. Sep 1997;30(3):347-9.

 

By |2021-03-01T09:25:47-08:00Sep 1, 2010|Gastrointestinal, Tricks of the Trade|
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Getting a subpoena: What is an expert witness?

Gavel

Well, it’s an inevitable part of working in an Emergency Department. I got a subpoena recently and now have to go in to testify on a trauma patient. I’ve gotten a few subpoenas before on trauma patients, but fortunately most cases were settled out of court.

First of all, I think it’s an ethical responsibility of emergency physicians to describe what we saw and did in the care of the injured patient in the legal system. However, I have found that the few lawyers I have interacted with slowly expand their scope of questions to cover things NOT in the medical chart. Has this happened to anyone else? They essentially start to ask me things which an “expert witness” should answer. Expert witnesses receive expert witness fees. (more…)

By |2019-02-19T18:53:03-08:00Aug 31, 2010|Medical Education|
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Article Review: Rethinking the premed requirements

PremedThink back to your college years. Remember those premed courses that you had to take? Biology, chemistry, physics… oh my. How helpful were these in your preparation for medical school and clinical practice?

In 1981, the Association of American Medical Colleges assembled a group, the General Professional Education of the Physician and College Preparation for Medicine (GPEP) to relook at these premed requirements. In 1984, the published a report “Physicians for the Twenty-First Century”. They advocated that the intensive premed requirements overly skews students’ education towards a “narrow objective of medical school admission”. Education is not balanced to include broader liberal arts learning, which may teach students more about humanistic values and communication skills. 

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By |2016-11-11T19:00:31-08:00Aug 30, 2010|Education Articles, Medical Education|
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Paucis Verbis card: TIMI risk score

Chest PainHow do you risk-stratify undifferentiated chest pain patients in the Emergency Department? There are a multitude of causes for chest pain. We are always taught to think of the 5 big life-threats: ACS, PE, aortic dissection, tension pneumothorax, and pericardial tamponade.

So how do YOU risk-stratify your patients for unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI)? STEMI’s are usually obvious. UA and NSTEMIs — not so much.

Fortunately a 2000 JAMA article and a followup Academic Emergency Medicine 2006 study have solidified the TIMI risk scoring system as a reasonable risk-stratification tool for all-comer ED patients with chest pain requiring an ECG.

Generally there is an upslope in risk at a TIMI score of 3 and greater.

PV Card: TIMI Risk Score


Adapted from [1, 2]
Go to ALiEM (PV) Cards for more resources.

References

  1. Pollack C, Sites F, Shofer F, Sease K, Hollander J. Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population. Acad Emerg Med. 2006;13(1):13-18. [PubMed]
  2. Antman E, Cohen M, Bernink P, et al. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA. 2000;284(7):835-842. [PubMed]
By |2021-10-18T10:09:44-07:00Aug 27, 2010|ALiEM Cards, Cardiovascular|
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