About Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco

Trick of the trade: Percuss the spine in low back pain

Many patients present to the Emergency Department for low back pain. Determining whether these patients have a red-flag diagnosis can be difficult. Red flag diagnoses include:

Fracture
Cauda equina syndrome/ spinal cord compression
Spinal infection
Vertebral malignancy

Almost all patients presenting with back pain, whether it be a muscle spasm or a spinal epidural abscess, will have back tenderness to some extent. So, how can you better differentiate benign from dangerous etiologies?

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By Michelle Lin, MD|2016-11-11T19:01:21-08:00May 5, 2010|Tricks of the Trade|

Poll: How do you recover from a night shift?

There are so many amazing things that we get to see and do as emergency physicians.

We see sick, undifferentiated patients who need our help acutely.
We have cool toys, such as ultrasounds.
We get to do great procedures.
We work on a shift-based schedule.
We work in team-based fashion with fun nurses, technicians, and staff.

However, one major down side is that almost all of us work some night shifts.

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By Michelle Lin, MD|2019-09-10T14:05:52-07:00May 4, 2010|Life|

Article review: Mentoring in EM

This article in the Canadian Journal of Emergency Medical Care reviews the EM literature on mentoring. The authors specifically do a great job summarizing practical tips.

What is a mentor?

It is a person who supports and guides a junior colleague (junior faculty member, residents, or medical student) in his/her professional development.

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By Michelle Lin, MD|2016-11-11T19:01:21-08:00May 3, 2010|Education Articles, Medical Education|

Paucis Verbis card: Vasopressors and Inotropes for Shock

The treatment of shock should focus on correcting the underlying pathophysiology. With persistent hemodynamic instability, a vasopressor and/or inotrope should be selected. Reviewing receptor physiology can help you select the best-fit agent for the patient’s clinical condition. There is an especially useful table on medication selection in the reviewed 2008 EM Clinics of North America article.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews Vasopressors and Inotropes for the Treatment of Shock.

PV Card: Vasopressors and Inotropes in Shock

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

Edit 3/28/14: Dopamine removed as second-tier agent for septic shock (mainly reserved for rare cases of inappropriate bradycardia at low risk for arrhythmias)

Reference

Ellender T, Skinner J. The use of vasopressors and inotropes in the emergency medical treatment of shock. Emerg Med Clin North Am. 2008;26(3):759-86, ix. [PubMed]

By Michelle Lin, MD|2021-10-19T18:48:16-07:00Apr 30, 2010|ALiEM Cards, Cardiovascular, Tox & Medications|

Trick of the Trade: Radial Gutter Splint

How do you splint 2nd or 3rd metacarpal fractures? A short arm volar splint is usually applied, because a fracture should be immobilized one joint distal and proximal to the injury. This splint, however, unnecessarily immobilizes the 4th and 5th fingers. It makes gripping things with your hand difficult.

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By Michelle Lin, MD|2016-11-07T08:31:32-08:00Apr 28, 2010|Orthopedic, Tricks of the Trade|

Paucis Verbis card: Skipping the CT prior to LP for meningitis

With increasing awareness of CT’s irradiation risk, I thought I would review a classic 2001 article from the New England Journal of Medicine. Head CT’s previously were commonly performed prior to all lumbar punctures (LP) to rule-out meningitis. When can you safely go straight to an LP without imaging?

Caveat: This review only applies to those patients in whom you suspect meningitis. This does not apply to those being worked up for subarachnoid hemorrhage.

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By Michelle Lin, MD|2021-10-19T19:36:53-07:00Apr 23, 2010|ALiEM Cards, Neurology, Radiology|

Trick of the Trade: A "handy" ruler

How long is this neck laceration?

In the Emergency Department, it is important to be able to accurately estimate the length of wounds, abscesses, and cellulitis. Additionally, billing for wound closure is directly related to the length of the laceration.

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By Michelle Lin, MD|2016-11-11T19:01:22-08:00Apr 21, 2010|Tricks of the Trade|

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