We commonly see patients with shoulder dislocations in the Emergency Department. There are a myriad of approaches in relocating the joint, which includes scapular rotation, Snowbird, and Kocher maneuvers.
I recently stumbled upon the Cunningham technique after hearing about it from Dr. Graham Walker (of MDCalc fame) on TheCentralLine.org.
How often has this happened to you —
You are in the middle of a sterile procedure (chest tube, suturing, central venous line, lumbar puncture) and you realize that you need more lidocaine to provide better topical anesthesia. You don’t have any more in your kit and you are alone in the room with the patient.
“Uh, can someone help me out there?”
How great would it be if you could give patients concrete numbers when you are talking about cancer risk and CT? Well, Dr. Hans Rosenberg (Univ of Ottawa) has come up with just such a table.
Using this table you can say that the risk is about “one in …”
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.
Fingertips can get injured in a variety of ways such as machetes, meat grinders, and broken glass. You name it, and we’ve probably seen it. Some don’t actually need anything invasive done because the skin is basically just torn off. The wound just needs to be irrigated, explored, and then bandaged to allow for secondary wound closure.
What do you do if the finger injury keeps oozing and the finger tip is too painful for the patient to apply firm pressure? Poking the finger with 2 needles to perform a digital block seems a bit overkill.
“Should I get a D-Dimer test or CT chest angiogram on my patient with atypical chest pain to rule-out a pulmonary embolism?” This is a common question asked by emergency physicians on a routine basis.
Here are 3 clinical prediction rules: PERC, Wells, and Simplified Geneva Score. Personally, I’ve never used the Geneva Score, but it’s worth looking at.
These rules should be used with caution, because none of these scoring protocols are perfect. For instance, in a recent publication in the Journal of Thrombosis and Haemostasis, the authors found that the PERC rule does not actually safely exclude PEs.1 Big bummer for us clinicians.
Go to ALiEM (PV) Cards for more resources.
Thanks to Dr. Kit Tainter (Mount Sinai PGY-4 EM resident) for coming up with the idea for this card!
I have heard of using tea bags under your eyes to reduce puffiness, but to combat odors in the ED?
In my growing list of “Tricks of the Trade” tips for protecting your olfactory nerves (Antacid booties for toxic sock syndrome, aerosolized orange juice, abscess drainage using suction), I got a clinical gem from Dr. James Juarez (Rogue Valley Medical Center in Ashland, OR) after my recent Tricks of the Trade talk at High Risk EM in San Francisco.
The classic prior teaching for the treatment of diverticulitis includes:
Do ALL patients need to be admitted? There is some early literature suggesting that there is a small sub-population who fare well with outpatient treatment.
This article from Annals of EM in the “Best Available Evidence” series summarizes the existing literature well.
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.
This paper only provides guidelines, based on the limited evidence out there. Still use your common sense. For instance, I’d still admit patients who are elderly (>80 years old) or have evidence of any perforation on CT. If on the fence, admit the patient.
Still it’s nice to see that the treatment of uncomplicated diverticulitis on an outpatient basis has some supporting literature.