Paucis Verbis card: ABG interpretation

I have yet to find a better arterial blood gas interpretation review article than the 1991 Western Journal of Medicine summary by Dr. Rick Haber.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews ABG Interpretation. The recent addition of an ABG machine in our ED has made a tremendous difference in our ability to care for undifferentiated patients. This is a refresher in making heads and tails of mixed acid-base disorders.

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

Reference

Haber R. A practical approach to acid-base disorders. West J Med. 1991;155(2):146-151. [PubMed]

By Michelle Lin, MD|2021-10-19T18:53:19-07:00Apr 2, 2010|ALiEM Cards, Endocrine-Metabolic, Pulmonary|

Tricks of the trade: Anesthetizing the nasopharyngeal tract

Nasogastric tube placement is one of the most uncomfortable procedures in the Emergency Department. Why can’t we find a painless way to do this?

Now that I am doing more fiberoptic nasopharyngoscopes, this issue is coming up more and more frequently. I’ve been using NP scopes mainly to check for laryngeal edema in the setting of angioedema. These recent photos visualize a normal epiglottis and normal laryngeal anatomy, respectively.

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By Michelle Lin, MD|2016-11-11T19:01:27-08:00Mar 31, 2010|Tricks of the Trade|

Great teaching video: Corneal FB removal

Patients often come into the ED for eye pain. One of my favorite procedures is removal of a small foreign body embedded in the cornea. There is a great instructional video on removing such foreign bodies and the use of a ophthalmic burr on removing rust rings.

The video recommends using either a 30-gauge or 18-gauge needle. I prefer the less innocuous-looking 29-gauge insulin/TB needle. Can you imagine someone coming towards your eye with a large 18-gauge needle?!

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By Michelle Lin, MD|2019-01-28T23:44:07-08:00Mar 30, 2010|Ophthalmology|

Paucis Verbis card: Angioedema

Recently, a patient presented with angioedema after starting taking an ACE-inhibitor. There was upper lip swelling, similar appearing to the case above. He also experience a hoarse voice. Before the advent of fiberoptic nasopharyngoscopy, it was assumed that there may be laryngeal edema. Fortunately, using technology, we were able to visualize a normal epiglottis and a grossly normal laryngeal anatomy.

Should patient with angioedema be admitted?

The 1999 study on admission guidelines, of course, should be weighed with physician judgment and the patient’s social issues. The study was retrospective and the results should be weighed carefully. For me, generally I admit all cases involving intraoral structures and progressively worsening extraoral angioedema. I also perform fiberoptic nasopharyngoscopy on all patients with voice changes.

PV Card: Angioedema

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

Reference

Temiño V, Peebles R. The spectrum and treatment of angioedema. Am J Med. 2008;121(4):282-286. [PubMed]

By Michelle Lin, MD|2021-10-19T18:55:31-07:00Mar 26, 2010|ALiEM Cards, Allergy-Immunology, ENT|

Trick of the trade: Ear foreign body extraction

A 6-year old boy has placed a hard bead in his ear and presents to the ED for care. How do you remove this foreign body as painlessly as possible? You can just barely see the edge of the bead by just looking at the external ear.

By experience, you know that mini-Alligator clips and forceps will not be able to sufficiently grab the edges of the bead. Additionally it may push the bead in even further.

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By Michelle Lin, MD|2019-02-19T18:08:04-08:00Mar 24, 2010|ENT, Tricks of the Trade|

Paucis Verbis card: Knee exam

How accurate is the clinical knee exam?

JAMA published a meta-analysis trying to answer this question. Although they include patients with acute and chronic knee pain, it’s a good general review of the knee anatomy, historical clues, and exam elements.

In the ED, the knee exam is challenging because we see very acute injuries where knee pain and swelling often preclude an accurate exam. For patients with an equivocal exam, be sure to refer for orthopedic follow-up. A repeat exam should be performed once the pain and swelling subside.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews the Knee Exam.

I used to be all confused and had a hard time memorizing all the different maneuvers (especially for the meniscus). It is much easier to remember after doing these knee exams routinely. Particularly, the lateral pivot test and McMurray test can be done with several rounds of simultaneous knee flexion-extension, internal-external rotation, and valgus stressing. Looking at diagrams almost makes things more confusing.

PV Card: Knee Exam

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Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-19T18:57:31-07:00Mar 19, 2010|ALiEM Cards, Orthopedic|

Tricks of the trade: Chemical sedation options

You walk into a room where a patient is screaming and thrashing about in his/her gurney from some stimulant abuse. PCP, cocaine, methamphetamine… or all of the above.

When the number of people (police officers, security guards, nurses) is greater than the patient’s pupil size, you KNOW that you’ll need some chemical sedation.

What intramuscular sedation regimen do you use?

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By Michelle Lin, MD|2016-11-11T19:01:31-08:00Mar 17, 2010|Tricks of the Trade|