Paucis Verbis card: Burn Wounds

Burn classification and management are key skills for ED providers to remember. Depending on the prevalence of burns in your ED, it may be hard for forget the details. So here is a PV reference card on the rule of 9’s, different classifications of burns, and indications for burn unit referral.

Update (April 22, 2016): This card was updated by Dr. Christian Rose (UCSF-SFGH) to reflect current evidence that topical antibiotics and honey are IN, while silver sulfadiazine is OUT for partial-thickness burns.

PV Card: Burn Wounds

Adapted from [1-3]
Go to ALiEM (PV) Cards for more resources.

References

Gómez R, Cancio L. Management of burn wounds in the emergency department. Emerg Med Clin North Am. 2007;25(1):135-146. [PubMed]
Malik K, Malik M, Aslam A. Honey compared with silver sulphadiazine in the treatment of superficial partial-thickness burns. Int Wound J. 2010;7(5):413-417. [PubMed]
Jull A, Cullum N, Dumville J, Westby M, Deshpande S, Walker N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev. 2015;(3):CD005083. [PubMed]

By Michelle Lin, MD|2021-10-18T10:23:37-07:00Jul 2, 2010|ALiEM Cards, Dermatology, Trauma|

Trick of The Trade: Peritonsillar Abscess Drainage 2.0

Back in September of 2009 Michelle shared valuable Tricks of The Trade regarding drainage of peritonsillar abscesses. Today we revisit the topic and add two more tricks to avoid hitting “big red” a.k.a. the internal carotid artery.

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By Demian Szyld, MD EdM|2019-07-30T15:36:32-07:00Jun 30, 2010|ENT, Tricks of the Trade, Ultrasound|

Paucis Verbis card: Ascites assessment with paracentesis

A paracentesis procedure is often performed in the Emergency Department to rule a patient out for spontaneous bacterial peritonitis (SBP).

Do you check coagulation studies before performing the procedure?
How comfortable do you feel that the patient has SBP with an ascites WBC > 500 cells/microliter or ascites PMN > 250 cells/microliter?

This installment of the Paucis Verbis (In a Few Words) e-card series provides an evidence-based review of the literature on topics related to the paracentesis procedure. Especially helpful is the pooled data of likelihood ratios. Like most everything in medicine, a lab test should be used in conjunction with your pretest probability in clinical decision making, and LR’s help with with this.

PV Card: Ascites and Paracentesis

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

Reference

Wilkerson RG, Sinert R. The Use of Paracentesis in the Assessment of the Patient With Ascites. Annals of Emergency Medicine. 2009;54(3):465-468. doi: 10.1016/j.annemergmed.2008.09.005

By Michelle Lin, MD|2021-10-18T10:26:22-07:00Jun 25, 2010|ALiEM Cards, Gastrointestinal|

Trick of the Trade: Finding the subtle pneumothorax

Can you see the pneumothorax?

Small pneumothoraces can be difficult to detect on chest xrays. Overlying ribs, other bony structures, and soft tissue can obscure subtle findings. For a patient at risk for a small pneumothorax, you can use your digital radiology PACS system to improve your ability to spot them.

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By Michelle Lin, MD|2016-11-11T19:00:42-08:00Jun 23, 2010|Radiology, Tricks of the Trade|

Paucis Verbis card: Appendicitis – ACEP Clinical Policy

Appendicitis is a common presentation in the Emergency Department. Dilemmas arise when deciding whether to image patients with equivocal symptoms and WBC lab results. Given the risk of ionizing radiation with CT scans, we should ideally minimize the number of CT scans ordered in these patients without mistakenly sending patients home with an early appendicitis. A perforated appendix places the patient at risk for bowel obstruction, infertility (in women), and sepsis.

Where does the American College of Emergency Physicians (ACEP) stand on the critical issues surrounding the evaluation of appendicitis?

This installment of the Paucis Verbis (In a Few Words) e-card series reviews the ACEP Clinical Policy on Appendicitis. In the end, the policy conjures up more questions than answers, but a comprehensive presentation of the literature to date and helpful risk-stratification data are provided.

PV Card: ACEP Clinical Policy on Appendicitis

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

Reference

Howell J, Eddy O, Lukens T, et al. Clinical policy: Critical issues in the evaluation and management of emergency department patients with suspected appendicitis. Ann Emerg Med. 2010;55(1):71-116. [PubMed]

By Michelle Lin, MD|2021-10-18T10:28:05-07:00Jun 18, 2010|ALiEM Cards, Gastrointestinal|

Trick of the Trade: Double staple gun

How do you approach the repair of scalp lacerations in a child? What factors are you considering?

Is the wound suspicious for child abuse?
Procedural sedation versus local anesthesia of the wound
Staples versus hair apposition technique (HAT trick) for wound closure

This trick of the trade pearl addresses the stapling technique for scalp laceration repair. Perhaps the child’s hair is too short for the HAT trick.

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By Michelle Lin, MD|2019-02-19T18:33:04-08:00Jun 16, 2010|Tricks of the Trade|

Paucis Verbis card: Septic Arthritis

In the workup of monoarticular arthritis, the question that emergency physicians constantly struggle over is whether the patient has a nongonococcal septic arthritis. This joint infection alarmingly damages and erodes cartilage within only a few days.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews the JAMA Rational Clinical Examination article which asks “Does this patient have septic arthritis?” Pooled sensitivities and likelihood ratios were calculated. These statistics are always helpful when trying to figure out the patients probability of having a septic joint.

I was surprised to learn that only about 50% of patients with septic joints have a fever. Note that a hip or knee prosthesis PLUS an overlying skin infection pretty much equals a septic joint (LR = 15.0).

Risk factors are listed in the table with the corresponding sensitivities, specificities, and likelihood ratios.

PV Card: Septic Arthritis

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Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-19T19:42:49-07:00Jun 11, 2010|ALiEM Cards, Infectious Disease, Orthopedic|