Tricks of the Trade: Ultrasound workshop setup

Have you ever been to an ultrasound workshop where each small group of attendees huddles around the small ultrasound display? Personally I think the 3 people closest to the display really see the images well. This tends to exclude the other participants.

Last week, I hosted (my first!) ultrasound workshop for the UCSF Alumni CME Conference where I showed peri-retired UCSF alumni from various specialties about the future of bedside ultrasonography. I equated it to the 21st century stethoscope. Thanks to my star team of ultrasonographers: Dr. Asaravala, Flores, Miss, Lenaghan, and Wilson.

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By Michelle Lin, MD|2016-11-11T18:54:22-08:00May 11, 2011|Tricks of the Trade, Ultrasound|

Paucis Verbis: Brugada syndrome

You always hear about it when working up syncope and sudden cardiac arrest in young patients, but it’s so easy to forget what it looks like on ECG. We so rarely see it… or DO we?!

This Paucis Verbis card on Brugada Syndrome is to help emblazon these ECG tracings in our mind, so that we don’t miss the subtle findings which place a patient at risk for sudden cardiac death. Pay special attention to Type 1, which is most specific for Brugada Syndrome.

PV Card: Brugada Syndrome

* Update 8/2/18: Only Type 1 and Type 2 are recognized for Brugada syndrome. The type 3 pattern is likely a normal variant.

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

Reference

Antzelevitch C. Brugada Syndrome: Report of the Second Consensus Conference: Endorsed by the Heart Rhythm Society and the European Heart Rhythm Association. Circulation. 2005;111(5):659-670. doi:10.1161/01.cir.0000152479.54298.51

By Michelle Lin, MD|2021-10-15T11:04:55-07:00May 6, 2011|ALiEM Cards, Cardiovascular, ECG|

Trick of the Trade: Temperomandibular (TMJ) dislocation

Mandible, or TMJ, dislocations occur when the patient excessively opens the mouth, such as in a yawn. They are typically bilateral and are difficult to relocate because of masseter and medial pterygoid muscle spasm. You can relocate the condyles back into the TMJ space with gentle but firm intraoral pressure inferiorly and posteriorly. Often it requires some sedation to help relax the muscles of mastication.

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By Michelle Lin, MD|2019-01-28T22:49:39-08:00May 4, 2011|ENT, Tricks of the Trade|

Paucis Verbis: Asthma classification

Emergency physicians have the opportunity to educate patients and prescribe chronic inhaled corticosteroids to patients who should be on these medications chronically. Patients may be more receptive to education and advice given immediately after an asthma exacerbation, managed in the ED. Using the National Institute of Health/ National Asthma Education and Prevention Program classification system, physicians can quickly determine if the patient is a candidate for inhaled corticosteroids and initiate therapy accordingly.

PV Card: Asthma Classification system

In short, patients can be classified into one of 4 classes: intermittent, mild persistent, moderate persistent, and severe persistent asthma. Patients in these classes should receive either Step 1, 2, 3, or 4/5 medications, respectively. I remember that patient using daily short-acting beta agonists (SABA) belong to the moderate persistent asthma category.

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Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-15T11:08:17-07:00Apr 29, 2011|ALiEM Cards, Pulmonary|

Trick of the trade: Nebulized … orange juice?

In my theme of detoxifying malodorous smells in the ED, I recently learned of a new way of masking odors. Imagine the stress on your olfactory nerves from the combined effects of urinary and fecal incontinence from a nursing home patient.

An ingenious nurse proposed nebulizing actual coffee within the room. Unfortunately, our ED was out of coffee at the moment.

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By Michelle Lin, MD|2019-01-28T22:40:09-08:00Apr 27, 2011|Tricks of the Trade|

Paucis Verbis: Dental infections

To follow up with the wildly popular Paucis Verbis card made by Dr. Hans Rosenberg (University of Ottawa), here is his card on Dental Infections. This card summarizes common dental infection complaints (like the periapical abscess seen to the right) that we see in the Emergency Department.

PV Card: Dental Infections

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

Reference

Nguyen D, Martin J. Common dental infections in the primary care setting. Am Fam Physician. 2008;77(6):797-802. [PubMed]

By Michelle Lin, MD|2021-10-15T11:10:29-07:00Apr 22, 2011|ALiEM Cards, Dental|

Trick of the Trade: Corneal reflex test

The corneal reflex test (blink test) examines the reflex pathway involving cranial nerves V and VII. Classically the provider lightly touches a wisp of cotton on the patient’s cornea. This foreign body sensation should cause the patient to reflexively blink.

This maneuver always makes me a little worried about causing a corneal abrasion, especially if you are examining a very somnolent patient. You are wondering — Is there no blinking because you’re not touching the cornea hard enough? You apply harder pressure but still no blink. You repeat the test and now the patient finally blinks. That’s 3 times you’ve just scraped against the cornea.

What’s an alternative approach?

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By Michelle Lin, MD|2016-11-11T18:58:00-08:00Apr 20, 2011|Neurology, Tricks of the Trade|