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

By Michelle Lin, MD|2021-10-18T10:26:22-07:00Jun 25, 2010|ALiEM Cards, Gastrointestinal|

Blog’s one year anniversary

The blog is already one year old! What started initially as a little educational experiment has now evolved into a potentially long-term endeavor. It was initially built as a sort of personal journal of what I’ve learned and read about in the field of academic emergency medicine and educational technologies. Now I’ve it focuses on academics, clinical emergency medicine (Paucis Verbis cards), faculty and resident development, and technologies.

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By Michelle Lin, MD|2019-09-10T14:04:52-07:00Jun 24, 2010|Life|

Trick of the Trade: Finding the subtle pneumothorax

Can you see the pneumothorax?

Small pneumothoraces can be difficult to detect on chest xrays. Overlying ribs, other bony structures, and soft tissue can obscure subtle findings. For a patient at risk for a small pneumothorax, you can use your digital radiology PACS system to improve your ability to spot them.

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By Michelle Lin, MD|2016-11-11T19:00:42-08:00Jun 23, 2010|Radiology, Tricks of the Trade|

Hot off the press: Journal of Graduate Medical Education

In 2009, ACGME has launched a new journal focused on graduate medical education, called the Journal of Graduate Medical Education (JGME). For those of you with education manuscripts in need of a “home”, consider this peer-reviewed journal. It publishes quarterly.

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By Michelle Lin, MD|2019-01-28T23:38:52-08:00Jun 22, 2010|Medical Education|

Article Review: Impact of family presence in a code

Family presence in the ED resuscitation of a dying patient is a controversial topic. Some surveys suggest that families favor this practice and would repeat it again in a similar situation.

An article in Critical Care Medicine examines the impact of family presence on the ED personnel’s actions, rather than the impact on the families themselves. Second and third-year EM residents were randomized into paired teams in simulation exercises. All resuscitations involved a cardiac arrest patient. Each team was exposed to one of three types of resuscitation groups:

No family witness
Non-obstructive family witness (quiet person) – quiet crying and conversation with social worker
Overtly grieving family witness – loud crying, attempts to hug patient during resuscitation

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By Michelle Lin, MD|2016-11-11T19:00:42-08:00Jun 21, 2010|Medical Education|

Paucis Verbis card: Appendicitis – ACEP Clinical Policy

Appendicitis is a common presentation in the Emergency Department. Dilemmas arise when deciding whether to image patients with equivocal symptoms and WBC lab results. Given the risk of ionizing radiation with CT scans, we should ideally minimize the number of CT scans ordered in these patients without mistakenly sending patients home with an early appendicitis. A perforated appendix places the patient at risk for bowel obstruction, infertility (in women), and sepsis.

Where does the American College of Emergency Physicians (ACEP) stand on the critical issues surrounding the evaluation of appendicitis?

This installment of the Paucis Verbis (In a Few Words) e-card series reviews the ACEP Clinical Policy on Appendicitis. In the end, the policy conjures up more questions than answers, but a comprehensive presentation of the literature to date and helpful risk-stratification data are provided.

PV Card: ACEP Clinical Policy on Appendicitis

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

Reference

Howell J, Eddy O, Lukens T, et al. Clinical policy: Critical issues in the evaluation and management of emergency department patients with suspected appendicitis. Ann Emerg Med. 2010;55(1):71-116. [PubMed]

By Michelle Lin, MD|2021-10-18T10:28:05-07:00Jun 18, 2010|ALiEM Cards, Gastrointestinal|