Trick of the Trade: No pelvic bed? No problem

Often finding a pelvic examination bed for a female patient needing a speculum exam can be challenging. Without the elevated foot stirrups, the bed under the patient’s buttocks obstructs the pelvic speculum handle so that it can’t rotate completely into a 6 o’clock position.

Some people place an upside-down bed pan to elevate the patient’s buttocks slightly in order to create more space for the speculum. Not only is the position uncomfortable for the patient, it seems a waste of a perfectly good bed pan. Fortunately there is an alternative approach.

(more…)

By Michelle Lin, MD|2019-01-28T22:00:26-08:00Mar 26, 2013|Ob/Gyn, Tricks of the Trade|

Ketofol: Is this the “Game Changer” of Procedural Sedation and Analgesia?

When talking about procedural sedation and analgesia, our goal is to minimize pain and anxiety, with the appropriate agent that matches the needs of our patient and the clinical scenario. So what are some qualities of this “ideal agent?”

In a perfect world, it would have:

Minimal adverse effects
Rapid onset and offset of action
Pharmocokinetic predictability across a spectrum of patients

(more…)

By Salim Rezaie, MD|2021-03-01T09:32:06-08:00Mar 20, 2013|Tox & Medications|

First ALiEM journal article: Trial of void for acute urinary retention

A patient may present to the ED after foley catheter placement for acute urinary retention (AUR) a few days ago and now requests catheter removal. Ideally this should be performed in the urologist’s office. However, occasionally patients cannot or do not follow up with the urologist in a timely manner and return to the ED expecting urethral catheter removal. A careful history and physical should be performed along with a consulting urologist. If the eventual decision is to remove the urethral catheter in the ED, what is important to know about a Trial of Void (TOV)?

(more…)

By Javier Benitez, MD|2018-01-30T01:58:58-08:00Mar 19, 2013|Genitourinary|

Dr. Rahul Patwari reviews the basics of respiratory physiology, the pathophysiology behind respiratory failure, and ventilator management. What do all the ventilator settings mean?

(more…)

By Michelle Lin, MD|2019-01-28T22:00:36-08:00Mar 17, 2013|Patwari Videos, Pulmonary|

Is the physical exam a relic of the past, because our tools are relics of a prior era?

It is important to do and teach a thorough physical exam. I cautioned against the overreliance on diagnostic testing in lieu of a physical exam, which can be initially burdensome and prolonged. But perhaps our difficulty with the physical exam is not the exam itself, but the tools that we have at our disposal to perform an exam, rather than the exam itself.

(more…)

By Nikita Joshi, MD|2018-01-30T01:59:00-08:00Mar 15, 2013|Medical Education, Ultrasound|

What’s the Code Dose of tPA?

Suppose you have a patient in whom you highly suspect a pulmonary embolism (PE) that devolves into PEA arrest while awaiting a CT angiogram. Or, what about a patient with an ECG showing clear STEMI that loses pulses?

(more…)

By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2018-02-17T01:56:47-08:00Mar 14, 2013|Tox & Medications|

Lytics for sub-massive PE: Ready for primetime?

There was recently a great study published in the American Journal of Cardiology (2012) by Sharifi et al¹, questioning whether we should be considering tPA in patients other than those patients with massive pulmonary embolism (PE)? You know the big “Saddle Embolus” we all fear? Well it turns out this is only about 5% of all PEs.

Should we be considering tPA in patients with sub-massive PEs?

(more…)

By Salim Rezaie, MD|2019-09-10T13:37:21-07:00Mar 13, 2013|Cardiovascular, Pulmonary, Tox & Medications|

Previous 1···168 169 170 171 172 173174175 176 177 178 179 180···225 Next