Article Review: Premature diagnostic closure

You are taking care of a patient, who frequently presents to the ED for polysubstance use. You are pretty sure his altered mental status is from polysubstance use again. He was found in his home next to drug paraphernalia. He intermittently becomes severely agitated, and so you give him sedatives. He has a low-grade fever, but you attribute that to his psychomotor agitation and likely stimulant use. Because he remains confused and lethargic after 8 hours, you admit him to an inpatient team to await further metabolism of his recreational drugs and your sedation medications.

The next day, you learn that had meningoencephalitis.

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By Michelle Lin, MD|2016-11-11T19:00:36-08:00Jul 26, 2010|Education Articles, Medical Education|

Paucis Verbis card: Urine Toxicology Screen

In the Emergency Department, we often order urine toxicology screens for patients with altered mental status without an obvious cause. I find that patients are often rather forthcoming about their drug use, if they are alert enough to talk. In those cases, ordering a urine toxicology screen is unnecessary.

When you do order a tox screen, however, how do you interpret the information? While the result is a binary answer (positive vs negative), there are some nuances to interpretation. For instance, how long does a patient with urine toxicology remain positive for the drugs? Are there any medications that can cause false positives? See the helpful table below from a great review article in American Family Physician.

Check out what your laboratory screens for and, more importantly, what it does NOT screen for. Our lab, for example, does not screen for PCP but does screen for MDMA (ecstacy). That isn’t a big deal, since patients who ingest PCP aren’t too hard to detect clinically. They have crazy vertical nystagmus, and often there are at least 6 police officers trying to restrain the yelling patient.

PV Card: Urine Toxicology Screen

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

Reference

Standridge J, Adams S, Zotos A. Urine drug screening: a valuable office procedure. Am Fam Physician. 2010;81(5):635-640. [PubMed]

By Michelle Lin, MD|2021-10-18T10:17:50-07:00Jul 23, 2010|ALiEM Cards, Tox & Medications|

How to teach procedures in the Emergency Department

As I was going through the free EM-RAP Educator’s Edition podcasts, somehow missed the March 2010 podcast on how to teach procedures in the Emergency Department. In the 36-minute podcast, Dr. Mak Moayedi (Univ of Maryland) discusses a framework to teaching procedures. Check it out.

More specifically, Dr. Moayedi talks about how teaching procedures has moved beyond the antiquated “see one, do one, teach one” philosophy. Instead, we should follow principles based on accepted adult learning theories.

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By Michelle Lin, MD|2026-06-16T16:03:38-07:00Jul 15, 2010|Medical Education|

Trick of the Trade: OKN drum to test psychogenic coma

Occasionally, emergency physicians see patients who present because they are unresponsive despite normal vital signs and an otherwise normal exam. You detect no drugs or alcohol on board. You suspect a psychiatric or malingering etiology, but aren’t sure. They seem non-responsive to voice and minimally responsive to very painful stimuli. Is this a case of psychogenic coma or true coma (with bilateral hemispheric dysfunction)?

What test can you do to reassure yourself that this may indeed be psychogenic coma?

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By Michelle Lin, MD|2019-01-28T23:37:29-08:00Jul 14, 2010|Neurology, Tricks of the Trade|

Essential tool for academicians: Cordless presenter

In academic medicine, you inevitably will need to give presentations. This may include giving lectures on clinical topics, summarizing your research findings, or presenting your meeting agenda. Usually these are displayed using a laptop and a LCD projector. Depending on the room, you may or may not be provided a cordless presenter.

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By Michelle Lin, MD|2016-11-11T19:00:39-08:00Jul 13, 2010|Social Media & Tech|

Article Review: What do EM learners want from teachers?

Evaluations of clinical faculty typically incorporate comments from rotating medical students and residents regarding their teaching ability. In the Emergency Department (ED), how do you balance your pressing clinical responsibilities with teaching?

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By Michelle Lin, MD|2016-11-11T19:00:39-08:00Jul 12, 2010|Education Articles, Medical Education|

Paucis Verbis card: Penetrating abdominal trauma

When I did my residency training in Emergency Medicine and in the first few years as an attending, we regularly performed diagnostic peritoneal lavages in patients with stab wounds injuries to the abdomen. Patients also routinely went to the operating room for exploration.

Now with the evolution of CT imaging technology and more clinical studies, there is now a role for a less invasive management approach. These are the Eastern Association for the Surgery of Trauma (EAST) guidelines.

PV Card: Penetrating Abdominal Trauma

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

Reference

Como JJ, Bokhari F, Chiu WC, et al. Practice Management Guidelines for Selective Nonoperative Management of Penetrating Abdominal Trauma. The Journal of Trauma: Injury, Infection, and Critical Care. 2010;68(3):721-733. doi: 10.1097/ta.0b013e3181cf7d07

By Michelle Lin, MD|2021-10-18T10:21:39-07:00Jul 9, 2010|ALiEM Cards, Trauma|

About Michelle Lin, MD

PV Card: Urine Toxicology Screen

Reference

PV Card: Penetrating Abdominal Trauma

Reference