About Michelle Lin, MD

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

Paucis Verbis card: Early goal directed therapy

One of the landmark studies in sepsis was conducted by Dr. Emanuel Rivers (Henry Ford) and published in the New England Journal of Medicine in 2001. By managing patients with severe sepsis and septic shock with an “early goal directed therapy” approach, there was an absolute risk reduction of 16%. Furthermore, the number needed to treat to save a life was 6 patients!

This installment of the Paucis Verbis (In a Few Words) e-card series reviews Early Goal Directed Therapy algorithm. The layout is borrowed from a Cleveland Clinic Foundation (CCF) flowchart.

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

Reference

Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-1377. [PubMed]

By Michelle Lin, MD|2021-10-19T18:50:19-07:00Apr 16, 2010|ALiEM Cards, Infectious Disease|

Trick of the Trade: Retracting Swollen Eyelids

Eyelids can become edematous from blunt trauma and local inflammation, making it difficult to visualize the orbit. How do you retract the eyelids, if you don’t have the fancy ophthalmology eyelid retractors?

Trick of the Trade

Use a Q-tip

I thought of this idea when I was rolling up a projector screen in a conference room. Why can’t we use this rotational concept on the upper eyelid to retract it? Rest the Q-tip on the surface of the upper eyelid and slowly rotate the Q-tip to “roll” the eyelid out of the way.

Below are a series of photos of a woman with eyelid swelling from conjunctivitis. This technique provides a relatively painless way to retract the eyelid without placing pressure on the orbit itself. Although the images look like I am merely lifting the eyelid using the Q-tip, I am actually twirling the Q-tip.

Consent and photographs taken by Lourdes Adame
(Visual Aid Project member)

By Michelle Lin, MD|2019-01-28T23:42:58-08:00Apr 14, 2010|Ophthalmology, Tricks of the Trade|

Amazing video: Awake endotracheal intubation

Videos are priceless when trying to teach procedures. This amazing teaching video by Dr. Michael Bailin at Mass General demonstrates a novel way of anesthetizing the airway during an awake intubation.

Inject 3 cc of lidocaine using a small butterfly needle through the cricothyroid membrane. This causes coughing, which spreads the lidocaine throughout the upper airway.
Inject 5 cc of atomized lidocaine through the fiberoptic scope port to anesthetize the posterior oropharynx and vocal cords.
Slide the endotracheal tube over the fiberoptic scope.

(more…)

By Michelle Lin, MD|2019-01-28T23:43:42-08:00Apr 8, 2010|Medical Education|

Trick of the trade: Eye irrigation setup

Morgan lens are placed to irrigate eyes splashed with foreign substances. Whenever I place them, images of horror and torture movies arise. Especially for patients who aren’t used to having something touch their eyes like contact lens, the Morgan lens gives them the heeby-jeebies.

For the past several years, I’ve stopped using Morgan lens and have started using something that all Emergency Departments have — nasal cannulas for oxygen administration. They are perfect for high-volume eye irrigation.

Instead of attaching the nasal cannula to an oxygen port, attach it to the end of IV tubing, which in turn is attached to a 1 liter normal saline bag. The IV tubing fits snuggly into the nasal cannula tubing.

Rest the nasal cannula prongs over the patient’s nasal bridge to irrigate the eyes.
Then open up the flood gates!
To avoid a huge deluge of fluid onto the patient and floor, be sure to have a way to catch the fluid. Some place multitudes of towels around the patient’s head to absorb the fluid.
As an alternative solution to towels, I like Dr. Stella Yiu’s (Univ of Toronto) adaptation of my cut-out basin approach for irrigating scalp wounds. To avoid overflow spillage, she rests a Yankauer suction tip at the bottom of the basin to collect the irrigation fluid.

By Michelle Lin, MD|2019-02-19T18:53:53-08:00Apr 7, 2010|Ophthalmology, Tricks of the Trade|

Article review: Preparing for clinical clerkships during medical school

Do you remember the sheer terror you felt, when you first started your medical school clinical rotations? Your first two years were probably spent in classrooms and small-group labs discussing anatomy, pharmacology, pathology, etc.

Then BAM! You are thrown into the deep end of the pool. You are now on a clinical team of medical professionals taking care of actual patients!

(more…)

By Michelle Lin, MD|2016-11-11T19:01:26-08:00Apr 5, 2010|Education Articles, Medical Education|

Paucis Verbis card: ABG interpretation

I have yet to find a better arterial blood gas interpretation review article than the 1991 Western Journal of Medicine summary by Dr. Rick Haber.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews ABG Interpretation. The recent addition of an ABG machine in our ED has made a tremendous difference in our ability to care for undifferentiated patients. This is a refresher in making heads and tails of mixed acid-base disorders.

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

Reference

Haber R. A practical approach to acid-base disorders. West J Med. 1991;155(2):146-151. [PubMed]

By Michelle Lin, MD|2021-10-19T18:53:19-07:00Apr 2, 2010|ALiEM Cards, Endocrine-Metabolic, Pulmonary|

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