Paucis Verbis card: Acute limb ischemia

Acute limb ischemia (ALI) is a true vascular emergency. It doesn’t occur as frequently as the more high-profile conditions as cerebrovascular accidents and acute myocardial infarcts, but it portends similarly high morbidity and mortality risk.

How do you stage a patient with ALI, based on the Rutherford classification system?
What is the ED treatment plan?
Should this patient go to Interventional Radiology or the Operating Room for more definitive management?

PV Card: Acute Limb Ischemia with Rutherford Classification

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-12-21T13:31:37-08:00Aug 13, 2010|ALiEM Cards, Cardiovascular|

Trick of the Trade: Prescribing opiates

As emergency physicians, we are experts in pain control. We frequently write opiate prescriptions for patients being discharged home. Unfortunately, an occasional patient tries to forge my prescription. At times, I get a call from pharmacy for prescriptions that were suspiciously written. For instance several years ago, I had someone try to forge 100 tablets of “Mophine”.

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By Michelle Lin, MD|2016-11-11T19:00:35-08:00Aug 4, 2010|Tox & Medications, Tricks of the Trade|

YouTube increases limit to 15 minutes

I have slowly been building my video database of instructional media on YouTube under my YouTube Channel called “ITIMEinEM“. It stands for Innovative Technologies In Medical Education in Emergency Medicine. All of the videos have been used in this blog.

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By Michelle Lin, MD|2016-11-11T19:00:35-08:00Aug 3, 2010|Social Media & Tech|

Paucis Verbis card: Strep pharyngitis

Have you heard of the Modified Centor Score for strep pharyngitis? Interestingly, it has been validated in adults and children. The methodology builds on the traditional Centor Score by incorporating the patient’s age, because this disease is more prevalent in kids than adults. In fact, you actually lose a scoring point if you are older than 44 years old.

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By Michelle Lin, MD|2021-10-18T10:16:16-07:00Jul 30, 2010|ALiEM Cards, ENT, Pediatrics|

Brain Slides: My new favorite blog

I just encountered a new blog called Brain Slides: Presentation Design for Educators, written by Nathan Cashion. This blog eloquently teaches how Powerpoint should and, more importantly, shouldn’t be used.

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By Michelle Lin, MD|2016-11-11T19:00:36-08:00Jul 29, 2010|Social Media & Tech|

Trick of the Trade: Foley balloon be gone!

An urethral Foley catheter can sometimes become retained in the bladder, because of its balloon being unable to deflate. A malfunctioning inflation valve or obstructed channel along the length of the catheter is the cause.

How can you deflate the balloon so that the Foley catheter can be removed?

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By Michelle Lin, MD|2016-11-11T19:00:36-08:00Jul 28, 2010|Genitourinary, Tricks of the Trade|

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.