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.
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.
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:
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.
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.
How do you approach the repair of scalp lacerations in a child? What factors are you considering?
This trick of the trade pearl addresses the stapling technique for scalp laceration repair. Perhaps the child’s hair is too short for the HAT trick.
I recently came across a new means of online teaching and information delivery called sketchcasting. The premise isn’t new. It combines a podcast (someone speaking) with visuals (images). In sketchcasting, the images are instead someone drawing on a virtual whiteboard in real-time to convey information.
I recently found a sketchcast with stop-motion and speed-up effects, which really made the presentation dynamic and super-engaging. This sketchcast by Dan Pink (Author of “Drive: The Surprising Truth About What Motivates Us”) was created by the Royal Society for the Arts, Manufactures and Commerce (RSA).
In the workup of monoarticular arthritis, the question that emergency physicians constantly struggle over is whether the patient has a nongonococcal septic arthritis. This joint infection alarmingly damages and erodes cartilage within only a few days.
This installment of the Paucis Verbis (In a Few Words) e-card series reviews the JAMA Rational Clinical Examination article which asks “Does this patient have septic arthritis?” Pooled sensitivities and likelihood ratios were calculated. These statistics are always helpful when trying to figure out the patients probability of having a septic joint.
I was surprised to learn that only about 50% of patients with septic joints have a fever. Note that a hip or knee prosthesis PLUS an overlying skin infection pretty much equals a septic joint (LR = 15.0).
Risk factors are listed in the table with the corresponding sensitivities, specificities, and likelihood ratios.
Go to ALiEM (PV) Cards for more resources.