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?
“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.
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!
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.
I am developing a new microsimulation module to help EM clerkship students gain a more realistic exposure to high-acuity patients. Emergent conditions, such as ectopic pregnancy, acute tricyclic overdose, and ST elevation MI, are usually cared for by senior residents and attendings. Rarely are students primarily involved in these cases.
A man recently presents with knee pain after pivoting and torquing his knee while falling. He complains of concurrent mild ankle pain. He presents with this tib-fib xray. Realizing that a proximal fibular fracture can present concurrently with a medial malleolus fracture or deltoid ligament rupture, we obtained xrays of the ankle. We were looking for a Maisonneuve fracture.
Several times in the ED, I have needed a mirror for patient care.A moderately intoxicated patient presents with a facial or scalp laceration. S/he adamantly refuses to have it repaired in the ED, because of the disbelief of that there is indeed a laceration. You want to show the patient, using a mirror, but you don’t have one. (more…)