Paucis Verbis card: Interpretation of intraosseous blood

There is a growing number of normal volunteers who agree to get an intraosseous (IO) needle placed. Just search Intraosseous Needle on Youtube. Often you can draw blood out of the needle. How do you interpret the lab values? Are they the same as your peripheral blood draw? Should we even send the blood to the lab?

In a 2010 article in Archives of Pathology and Laboratory Medicine, peripheral IV blood from 10 volunteers was compared to blood drawn twice from a single IO line in the humerus. After discarding the first 2 mL of IO blood, the first IO sample was drawn (4 mL). Then a second IO sample was drawn (4 mL), which is equivalent to a sample with the first 6 mL discarded.

Interesting, not all IO labs correlated with IV labs. The good news is that a few critical ones do show correlation: creatitine, glucose, and hematocrit.

PV Card: Interpreting Labs from the IO Line

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

Thanks to Dr. Michael McGonigal at Trauma Professional’s Blog for posting about this.

Reference

Miller L, Philbeck T, Montez D, Spadaccini C. A new study of intraosseous blood for laboratory analysis. Arch Pathol Lab Med. 2010;134(9):1253-1260. [PubMed]

By Michelle Lin, MD|2021-10-11T15:23:29-07:00Jan 13, 2012|ALiEM Cards, Heme-Oncology|

Trick of the Trade: A removable guidewire

An essential skill of any innovative troubleshooter in the Emergency Department is the ability to recognize when one piece of equipment may be used elsewhere. For instance, what’s your go-to approach when looking for a spare guidewire? Let’s say you are trying to salvage an ultrasound-guided basilic vein IV catheterization.

Here’s where I go for guidewires:

Central line kits
Pneumothorax pigtail kits
Seldinger-based cricothyrotomy kits

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By Michelle Lin, MD|2016-11-11T18:51:26-08:00Jan 10, 2012|Tricks of the Trade|

Background

Serotonin syndrome is caused by the excess of serotonin and presents classically as:

Altered mental status
Autonomic instability
Neuromuscular hyperactivity

Fortunately, there’s a nice algorithm (Hunter’s decision rule) which helps you decide whether it is serotonin syndrome or not. I also include a table, which I adapted from a New England Journal of Medicine review article, which helps you to differentiate it from its mimickers, such as anticholinergic syndrome, neuroleptic malignant syndrome, and malignant hyperthermia.

PV Card: Serotonin Syndrome

Adapted from [1, 2]
Go to ALiEM (PV) Cards for more resources.

A video to remind you what clonus looks like:

Thanks to Dr. Steve MacDade (Univ of Florida, Jacksonville EM resident) for the idea!

References

Boyer E, Shannon M. The serotonin syndrome. N Engl J Med. 2005;352(11):1112-1120. [PubMed]
Ables A, Nagubilli R. Prevention, recognition, and management of serotonin syndrome. Am Fam Physician. 2010;81(9):1139-1142. [PubMed]

By Michelle Lin, MD|2021-10-11T15:32:25-07:00Jan 6, 2012|ALiEM Cards, Tox & Medications|

Trick of the Trade: Hip dislocation Part II

As a followup to the blog on the Captain Morgan technique for hip dislocations, I’d like to throw out another similar technique that also does NOT involve climbing up on the gurney.

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By Fred Wu, MHS, PA-C|2016-11-11T18:51:27-08:00Jan 3, 2012|Orthopedic, Tricks of the Trade|

Trick of the Trade: Tie-over dressing for scalp lacerations

Scalp lacerations are apparently a hot topic these days. This is the third post now on how to apply a bandage to a scalp laceration.

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By Michelle Lin, MD|2019-02-19T18:08:00-08:00Dec 20, 2011|Tricks of the Trade|

Trick of the Trade: Captain Morgan technique for hip dislocation

Relocation of a hip joint is often quite a sight to see in the ED. A commonly taught technique is the Allis maneuver (watch the first 45 seconds of the above video from the Medical College of Georgia). It has always seemed a bit precarious to me having someone stand on the patient’s bed.
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By Michelle Lin, MD|2019-01-28T22:23:16-08:00Dec 13, 2011|Orthopedic, Tricks of the Trade|

Paucis Verbis: Feedback card

Today’s Paucis Verbis card is a little different. This card focuses on helping you give talking points when giving feedback to a learner on shift. This could be a medical student or resident.

Dr. David Thompson (UCSF-San Francisco General Hospital) sent this great card to me and I thought it was too useful NOT to share. It’s handy on shift, which ultimately is the purpose of these Paucis Verbis cards. These are useful especially for senior residents, who are supervising medical students and junior residents.

This card can be used in many ways. For instance:

Print these cards and fill it out at the end of the shift. Give to the learner.
Pick 1-2 questions from the list below as launching points for your feedback discussion. You don’t have to overwhelm the learner by answering everyone item below. Sometimes less is more to be effective.

PV Card: End of Shift Feedback

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-11T15:37:33-07:00Dec 9, 2011|ALiEM Cards, Medical Education|

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