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|

Trick of the Trade: Double staple gun

How do you approach the repair of scalp lacerations in a child? What factors are you considering?

Is the wound suspicious for child abuse?
Procedural sedation versus local anesthesia of the wound
Staples versus hair apposition technique (HAT trick) for wound closure

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.

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By Michelle Lin, MD|2019-02-19T18:33:04-08:00Jun 16, 2010|Tricks of the Trade|

Sketchcasting on What Drives Us

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).

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By Michelle Lin, MD|2019-01-28T23:39:21-08:00Jun 15, 2010|Social Media & Tech|

Paucis Verbis card: Septic Arthritis

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.

PV Card: Septic Arthritis

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Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-19T19:42:49-07:00Jun 11, 2010|ALiEM Cards, Infectious Disease, Orthopedic|

Trick of the Trade: Finding the femoral vein by V-technique

I rarely access the femoral vein for central venous catheterization… except in medical or trauma resuscitations. Oftentimes in these resuscitations, there are too many people near the IJ or subclavian vein site. People are intubating, performing CPR, trying to get peripheral vein access, etc.

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By Michelle Lin, MD|2019-01-28T23:39:57-08:00Jun 9, 2010|Tricks of the Trade|

Article Review: Conceptual Model on Learner Reflection

Reflective journals and electronic portfolios are becoming increasingly popular within undergraduate and graduate medical education. I’m starting to be a believer in this learning approach, which teaches learners about professional development and life-long learning principles. Academic Medicine just published a great qualitative paper proposing a conceptual model for reflection.

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By Michelle Lin, MD|2019-02-19T18:43:35-08:00Jun 7, 2010|Education Articles, Medical Education|

SAEM 2010 (June 2-6, 2010)

The Society of Academic Emergency Medicine’s (SAEM) annual meeting starts this week. Instead of my regular posts, I thought I’d try using the Twitter widget to post real-time, first-hand accounts and photos from the conference.

SAEM is a very dynamic and productive conference, where academicians in Emergency Medicine meet to pow-wow about the future of our specialty.

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By Michelle Lin, MD|2016-11-11T19:00:44-08:00Jun 1, 2010|Medical Education|

About Michelle Lin, MD

PV Card: ACEP Clinical Policy on Appendicitis

Reference

PV Card: Septic Arthritis