Trick of the Trade: Subclavian line gone north

In patients requiring central venous access, which vein do you prefer? In descending order, I prefer subclavians, internal jugulars (IJ), and then femorals.

There is increasing evidence that subclavian central venous lines are superior to femoral lines (JAMA 2001) with respect to iatrogenic infection and thrombosis rates. In 9% of subclavian lines, however, the line tip ends up in the ipsilateral IJ, instead of the superior vena cava (SVC) – see chest xray below. These lines are unusable in the long term because of the risk of cathether thrombosis in this low-flow area. The line must must be rewired.

(more…)

By Michelle Lin, MD|2016-11-11T19:01:49-08:00Dec 2, 2009|Tricks of the Trade|

Faculty hero: Ernest Wang (part 1)

Ernest Wang, MD

Clinical Assistant Professor, NorthShore University HealthSystem

Academic Director, Center for Simulation Technology & Academic Research (CSTAR)
Associate Program Director, University of Chicago EM Residency

(more…)

By Michelle Lin, MD|2019-09-10T14:05:18-07:00Dec 1, 2009|Life|

Article Review: Hidden cost of reducing resident duty hours

Patient care versus education

This is the tug-of-war struggle that residency programs constantly grapple with. Residents work in an apprenticeship model where they are both patient providers and learners. Both are critical in residency training, but they sometimes negatively impact each other. For instance, EM residents hand-off their patients to covering residents while attending their weekly conference classes. In contrast, residents may skip that day’s board teaching rounds to manage an acutely decompensating patient.

(more…)

By Michelle Lin, MD|2013-06-15T18:29:04-07:00Nov 30, 2009|Education Articles, Medical Education|

Trick of the Trade: Hum-out the jugular veins

Placing an IV in the external jugular vein requires venous distension maneuvers. This means having the patient perform a Valsalva maneuver or be placed in a Trendelenburg position.

Have you ever had a patient who didn’t quite get the Valsalva maneuver concept, or couldn’t tolerate a head-down position?

(more…)

By Michelle Lin, MD|2016-11-11T19:01:50-08:00Nov 25, 2009|Tricks of the Trade|

Article review: Commentary on graduate medical education in the U.S.

“How ready are medical students for the clinical practice of medicine?”

This was the question addressed by the landmark 1910 Flexner Report from the Carnegie Foundation for the Advancement of Teaching. Back in the early 1900’s, residency training did not exist yet, and students entered clinical practice immediately after graduation from medical school. The quality of medical training varied significantly with alarming deficiencies in many medical schools. An independent, nonprofessional organization was commissioned to report about the situation in order to pressure the public to reform medical school education.

(more…)

By Michelle Lin, MD|2016-11-11T19:01:50-08:00Nov 23, 2009|Education Articles, Medical Education|

Hot off the press: Review of EM Clerkship Primer book

In an upcoming issue of the Academic Emergency Medicine journal, there is a glowing review of a collaborative project that I was involved in. If you are a medical student about to do an EM rotation, or serve as a faculty advisor for an EM medical student, feel free to distribute this EM Clerkship Primer (FREE book!) for them to read. [Update 11/21/13: New link for free download PDF] This was the first official project to come out of the Clerkship Directors in Emergency Medicine (CDEM). It was written by 22 established medical educators in EM, led by our fearless leader/ editor-in-chief, Dave Wald. Go, Dave!

(more…)

By Michelle Lin, MD|2016-11-11T19:01:50-08:00Nov 20, 2009|Medical Education|

Trick of the Trade: The defensive arts against pimping

Thanks to Dr. Rob Roger’s podcast on EM-RAP Educator’s Edition series, I learned of one of the funniest publications EVER in a medical journal. It was published on April 1, 2009 in JAMA. The article focuses on teaching medical students the essential skill set– how to survive “pimping”.

Pimping traditionally occurs when an attending physician poses a difficult question to a learner in a public forum, such as board rounds or in the operating room. As a student or resident, you know that this will happen during your training, and you should be prepared. If you think of pimping as a form of battle, you will need a good defense, and you should mix it up to be successful.

(more…)

By Michelle Lin, MD|2026-06-16T16:03:40-07:00Nov 18, 2009|Medical Education, Tricks of the Trade|

About Michelle Lin, MD

Patient care versus education