Trick of the Trade: Blowing out the candle
How do you teach pediatric patients, especially toddlers, how to cooperate with your pulmonary exam? How do you get them to take adequately deep breaths in and out?
Work NOT in progress: ACEP Tricks of the Trade column
Since 2006, I have been the ACEP News columnist on “Tricks of the Trade in Emergency Medicine.“ Four years later, I’ve published and co-published 33 articles on various both low-tech and high-tech pearls.
It’s official — I’ll be stepping down from the ACEP News columnist position and handing off the reins to someone with fresher ideas. Frankly, I’m running out of innovative ideas worth publishing about.
Paucis Verbis card: Burn Wounds
Burn classification and management are key skills for ED providers to remember. Depending on the prevalence of burns in your ED, it may be hard for forget the details. So here is a PV reference card on the rule of 9’s, different classifications of burns, and indications for burn unit referral.
Update (April 22, 2016): This card was updated by Dr. Christian Rose (UCSF-SFGH) to reflect current evidence that topical antibiotics and honey are IN, while silver sulfadiazine is OUT for partial-thickness burns.
PV Card: Burn Wounds
Adapted from [1-3]
Go to ALiEM (PV) Cards for more resources.
References
- Gómez R, Cancio L. Management of burn wounds in the emergency department. Emerg Med Clin North Am. 2007;25(1):135-146. [PubMed]
- Malik K, Malik M, Aslam A. Honey compared with silver sulphadiazine in the treatment of superficial partial-thickness burns. Int Wound J. 2010;7(5):413-417. [PubMed]
- Jull A, Cullum N, Dumville J, Westby M, Deshpande S, Walker N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev. 2015;(3):CD005083. [PubMed]
Video: Caution about patient hand-offs in the ED
Kudos to Dr. Vineet Arora (Univ of Chicago) on creating a great video on the importance of clear, concise, and updated hand-off information on patients. This is especially important in the Emergency Department where patients are constantly being “signed out” to other residents for continued acute care. Whatever hand-off process you are using now, we can always do better.
Women in Academic EM video
As a joint project between Clerkship Directors in EM (CDEM) and the Academy for Women in Academic EM (AWAEM), there is a great 11 minute video about life in academic EM. For more information, check out AWAEM’s website.
Article Review: Evaluating students using RIME method
How do evaluate medical students and residents, who are rotating through your Emergency Department? Do you have a structured framework for assessing their competencies?
Have you heard of the RIME method of evaluating learners on their clinical rotation? Dr. Lou Pangaro (Vice Chair for Educational Programs in the Dept of Medicine at the Uniformed Services University) published a landmark article in 1999 on his simple yet effective approach in evaluating medical students and residents. I had the pleasure of briefly meeting Dr. Pangaro when he gave CDEM’s keynote speech in 2008.
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Paucis Verbis card: Ascites assessment with paracentesis
A paracentesis procedure is often performed in the Emergency Department to rule a patient out for spontaneous bacterial peritonitis (SBP).
- Do you check coagulation studies before performing the procedure?
- How comfortable do you feel that the patient has SBP with an ascites WBC > 500 cells/microliter or ascites PMN > 250 cells/microliter?
This installment of the Paucis Verbis (In a Few Words) e-card series provides an evidence-based review of the literature on topics related to the paracentesis procedure. Especially helpful is the pooled data of likelihood ratios. Like most everything in medicine, a lab test should be used in conjunction with your pretest probability in clinical decision making, and LR’s help with with this.
PV Card: Ascites and Paracentesis
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.
Reference
- Wilkerson RG, Sinert R. The Use of Paracentesis in the Assessment of the Patient With Ascites. Annals of Emergency Medicine. 2009;54(3):465-468. doi: 10.1016/j.annemergmed.2008.09.005