Paucis Verbis card: Croup

The most common cause of stridor in pediatric patients is croup, or laryngotracheobronchitis. The distinct high-pitched, seal-like,”barky” cough can be heard from outside the patient’s room often.

Check out the YouTube clip above. Go to the 1:15 mark (near the end) to hear the barking cough. Poor but cute kid.

What is the current treatment regimen? Did you know that the traditional treatment with cool mist or humidified air have shown to be of no added benefit?

PV Card: Croup

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Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-19T19:29:51-07:00Aug 20, 2010|ALiEM Cards, ENT, Infectious Disease, Pediatrics|

Trick of the Trade: Modified HAT trick revisited

I finally tried the Modified HAT (Hair Apposition Technique) trick for the closure of scalp lacerations. I have used the traditional HAT trick multiple times but not the modified technique.

What’s the difference?

Instead of using your fingers, the modified approach involves the use of two instrument clamps to help twist and pull the hair strands taut. It turns out that this makes a huge difference, especially for short hairs. The clamps allow you to grab the hair strands so much more securely, before instilling a tissue adhesive at the twisting points.

The nice added benefit was that my chubby fingers were now out of the procedural field. This allowed my assistant to more easily see and reach the hair twisting points with the Dermabond applicator.

Check out the finished product of this 2.5 cm laceration on the scalp vertex.

Bottom line

The simple addition of two instrument clamps provides significantly superior control, stronger tensile strength, and better exposure when twisting hair strands together. Try it.

By Michelle Lin, MD|2019-11-20T18:11:20-08:00Aug 18, 2010|Tricks of the Trade|

Paucis Verbis card: Acute limb ischemia

Acute limb ischemia (ALI) is a true vascular emergency. It doesn’t occur as frequently as the more high-profile conditions as cerebrovascular accidents and acute myocardial infarcts, but it portends similarly high morbidity and mortality risk.

How do you stage a patient with ALI, based on the Rutherford classification system?
What is the ED treatment plan?
Should this patient go to Interventional Radiology or the Operating Room for more definitive management?

PV Card: Acute Limb Ischemia with Rutherford Classification

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-12-21T13:31:37-08:00Aug 13, 2010|ALiEM Cards, Cardiovascular|

Paucis Verbis card: Procedural sedation and analgesia

From time to time, our patients need moderated and deep sedation in order to tolerate painful procedures such as joint reductions or incision and drainage procedures. There are many medications available to us including some newer ones such as Ketofol and Dexmedetomidine.

This week’s Paucis Verbis is a reference card to remind us of the importance of Airway Assessment and help us calculate the medication doses.

If you want to learn more about these medications and some strategies for different types of patients and procedures I recommend the EMCRIT Podcast PSA Lectures 1 and 2.

PV Card: Procedural Sedation and Analgesia

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

Reference

Walls RM, Brown CA. Approach to the difficult airway in adults outside the operating room. UpToDate. http://www.uptodate.com/contents/approach-to-the-difficult-airway-in-adults-outside-the-operating-room. Published November 2, 2016.

By Demian Szyld, MD EdM|2026-06-16T16:03:34-07:00Aug 6, 2010|ALiEM Cards, Tox & Medications|

Trick of the Trade: Prescribing opiates

As emergency physicians, we are experts in pain control. We frequently write opiate prescriptions for patients being discharged home. Unfortunately, an occasional patient tries to forge my prescription. At times, I get a call from pharmacy for prescriptions that were suspiciously written. For instance several years ago, I had someone try to forge 100 tablets of “Mophine”.

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By Michelle Lin, MD|2016-11-11T19:00:35-08:00Aug 4, 2010|Tox & Medications, Tricks of the Trade|

Paucis Verbis card: Strep pharyngitis

Have you heard of the Modified Centor Score for strep pharyngitis? Interestingly, it has been validated in adults and children. The methodology builds on the traditional Centor Score by incorporating the patient’s age, because this disease is more prevalent in kids than adults. In fact, you actually lose a scoring point if you are older than 44 years old.

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By Michelle Lin, MD|2021-10-18T10:16:16-07:00Jul 30, 2010|ALiEM Cards, ENT, Pediatrics|

Trick of the Trade: Foley balloon be gone!

An urethral Foley catheter can sometimes become retained in the bladder, because of its balloon being unable to deflate. A malfunctioning inflation valve or obstructed channel along the length of the catheter is the cause.

How can you deflate the balloon so that the Foley catheter can be removed?

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By Michelle Lin, MD|2016-11-11T19:00:36-08:00Jul 28, 2010|Genitourinary, Tricks of the Trade|