Paucis Verbis card: Supratherapeutic INR

What do you do in these cases?

A man on coumadin for atrial fibrillation arrives because he has increased bruising on his skin. He is otherwise asymptomatic. He was told to come to the ED because of a lab result showing INR = 6.
A woman on coumadin for atrial fibrillation arrives because of melena and hematemesis. She looks extremely sheet-white pale. Her vital signs are surprising normal. Stat labs show a hematocrit of 15 and an INR value that the lab is “unable to calculate” because it is so high.

Updated on 6/1/13: Old PV card revised to reflect the 2012 ACCP guidelines

By Michelle Lin, MD|2017-03-05T14:14:35-08:00Jan 15, 2010|ALiEM Cards, Heme-Oncology, Tox & Medications|

Trick of the Trade: Pediatric Distractors

Remember back in the day when we made simple toys for pediatric patients to focus on during the physical exam? Remember the inflated medical glove +/- a face drawn on it?

I just encountered a FREE iPhone application (Eye Handbook), which has a lot of useful features. I currently only use the Pediatric Fixation animations. They can be found under the “Testing” section. Kids (and often adults too!) become mesmerized and distracted by the cartoon animations.

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By Michelle Lin, MD|2019-01-28T23:45:44-08:00Jan 13, 2010|Pediatrics, Tricks of the Trade|

Paucis Verbis card: TIA prognosis

Here is another installment of the Paucis Verbis (In a Few Words) e-card series on the topic of Transient Ischemic Attacks (TIA) from EM Clinics of North America. I use this card a lot specifically for the ABCD2 risk-stratification score.

PV Card: Transient Ischemic Attacks

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

Reference

Ross M, Nahab F. Management of transient ischemia attacks in the twenty-first century. Emerg Med Clin North Am. 2009;27(1):51-69, viii. [PubMed]

By Michelle Lin, MD|2021-10-19T19:18:21-07:00Jan 8, 2010|ALiEM Cards, Neurology|

Trick of the Trade: Finger nailbed laceration repair

Over the years, I have been frustrated by how inelegant finger nailbed closure is. Nailbed lacerations are often sustained by a major crush injury, resulting in a stellate and irregular laceration pattern. This typically also requires the crushed fingernail to be removed. Cosmesis is never ideal because pieces of the nailbed are often missing, as seen in the photo above.

Occasionally, nailbed lacerations are caused by a cutting rather than a crush mechanism. In these cases, I use a different technique. I leave the fingernail on. In fact, I use the fingernail to help reapproximate the nailbed edges.

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By Michelle Lin, MD|2016-11-11T19:01:44-08:00Jan 6, 2010|Orthopedic, Tricks of the Trade|

Trick of the Trade: Hip flexion strength testing

Testing lower extremity strength is a crucial part of the examination in patients with low back pain. In Emergency Departments, however, some patients provide a suboptimal effort because of general fatigue or malingering.

How can you differentiate whether asymmetric hip flexion weakness is from suboptimal effort or true weakness?

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By Michelle Lin, MD|2016-11-11T19:01:45-08:00Dec 30, 2009|Tricks of the Trade|

Paucis Verbis Card: CNS Infections

PV Card: CNS Infections

Here is another installment of the Paucis Verbis (In a Few Words) e-card series on the topic of CNS infections from EM Clinics of North America 2009.

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

Reference

Somand D, Meurer W. Central nervous system infections. Emerg Med Clin North Am. 2009;27(1):89-100, ix. [PubMed]

By Michelle Lin, MD|2021-10-19T19:19:54-07:00Dec 29, 2009|ALiEM Cards, Infectious Disease, Neurology|

Paucis Verbis Project: A peripheral brain e-card series

A few days I wrote about my “peripheral brain” note cards that I carry with me on each ED shift. These cards contain brief summaries of updated guidelines, evidence based literature, and clinical pearls. I constantly get requests for a copy of them, but they are fairly outdated now that I’m out of residency.

So starting today, I’m going to start periodically posting new note cards in Word and PDF format that can be printed on any 4×6 inch index card. These will be posted every Friday. Feel free to download, edit, change font or font size, and use. You can add/remove cards as you collect them. Comments are definitely welcome.

Paucis Verbis Project

“Paucis verbis” means “in a few words” in Latin. I’ll initially start reviewing new articles from the Emergency Medicine Clinics of North America publication series. This is my favorite review resource in EM. It comes out every 3 months.

My first Paucis Verbis card will be a duo review. The first article is on shock by a super-star friend of mine, Dr. Matt Strehlow (Stanford). The second is first-authored by Dr. Philip Perera (Columbia) on the RUSH Exam and the role of ultrasonography in shock resuscitation.

PV Card: Shock

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Adapted from [1, 2]
Go to ALiEM (PV) Cards for more resources.

References

Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. Emerg Med Clin North Am. 2010;28(1):29-56, vii. [PubMed]
Strehlow M. Early identification of shock in critically ill patients. Emerg Med Clin North Am. 2010;28(1):57-66, vii. [PubMed]

By Michelle Lin, MD|2021-10-19T19:22:27-07:00Dec 22, 2009|ALiEM Cards, Cardiovascular|