Paucis Verbis: Management of Accidental Hypothermia

With all of the amazing, sunny weather here in California, I feel (briefly) terrible for all those braving the snowpocalyptic conditions across the United States. So, in honor of all those bundled up and shivering, I wanted to review the management of accidental hypothermia.

Tip: Avoid jostling the hypothermic patient too much because of myocardial irritability. Don’t send your patient into an arrhythmia.

PV Card: Management of Accidental Hypothermia

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-16T19:34:06-07:00Feb 4, 2011|ALiEM Cards, Environmental|

Trick of the Trade: Getting an EKG on Chewbacca

Patients with a hairy chest may require little patches of hair to be shaved when applying EKG leads. This allows the leads to stick firmly to the chest. Loose leads will result in either an artifactual signal or no signal at all on the EKG machine.

How can you obtain an EKG without shaving little patches on the patient’s chest?

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By Michelle Lin, MD|2026-06-16T16:03:23-07:00Feb 2, 2011|ECG, Tricks of the Trade|

Paucis Verbis card: The Shoulder Exam

How many times have you had to look up the shoulder exam maneuvers for patients with acute shoulder pain? I don’t know why I just can’t seem to remember these.

This Paucis Verbis card is a quick reference card to remind you of the most common techniques. Thanks to Jenny for the idea.

PV Card: Shoulder Exam

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-16T19:36:33-07:00Jan 28, 2011|ALiEM Cards, Orthopedic|

Paucis Verbis card: Generalized Convulsive Status Epilepticus

How do you manage patients who present in status epilepticus, knowing that “time is CNS function”? The longer patients remain seizing, the greater their morbidity and mortality.

Did you know that one study showed that 48% of their patients who presented in generalized convulsive status epilepticus (GCSE) had subtle persistent GCSE on EEG, despite no clinical evidence of overt seizure activity? That’s scary.

Do you send off a serum tricyclic toxicology screen for all your patients with GCSE? Because of the prevalence of TCA overdoses locally, our Neurology consultants definitely order it. We are picking up a surprising number of positive tricyclic tox screens.

PV Card: Status Epilepticus

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

Reference

Shearer P, Riviello J. Generalized convulsive status epilepticus in adults and children: treatment guidelines and protocols. Emerg Med Clin North Am. 2011;29(1):51-64. [PubMed]

By Michelle Lin, MD|2021-10-17T09:07:41-07:00Jan 21, 2011|ALiEM Cards, Neurology|

Tricks of the Trade: Nursemaid elbow reduction

We’ve all seen it before while working in the ED. A parent brings in their child because they pulled on their arm, and now the child is not using it. Parents are thoroughly convinced that the child’s arm is either broken or dislocated. We all recognize this as radial head subluxation or “nursemaid’s elbow” and immediately attempt to reduce it. The provider takes the injured arm, supinates at the wrist and flexes at the elbow. Does the child scream? What if nothing happens?

Is there an alternative technique to reducing a nursemaid elbow?

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By Fred Wu, MHS, PA-C|2016-11-15T22:02:31-08:00Jan 19, 2011|Orthopedic, Pediatrics, Tricks of the Trade|

Paucis Verbis card: Workup for first-time seizure

How do you workup adult patients who present with a new-onset seizure and now neurologically back to normal?

There unfortunately is very little recent literature about the best workup approach. In 1994, the American College of Emergency Physicians (ACEP) published a Clinical Policy based on expert consensus. The EM Clinics of North America series also just published a review on the topic. The bottom-line is that there are two types of workup approaches.

For the uncomplicated cases (age less than 40 years, afebrile, no comorbidities, no neurologic deficits), the workup is fairly minimal, which includes:

Glucose and electrolytes
Urine pregnancy test, if appropriate
+/- Urine toxicology screen
Head CT (noncontrast)

Otherwise, the more complex cases require a more extensive workup, which may include a lumbar puncture in the setting of a fever, severe headache, immunocompromised status, or persistent altered mental status.

Pearl

Be sure you obtain a head CT for patients who you think are presenting with a simple new-onset, alcohol-withdrawal seizure. One study showed that 6.2% of these patients actually have a significant lesion on CT (eg. bleed, mass).

PV Card: Workup for First Time Seizure

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

References

ACEP C, Clinical P. Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Ann Emerg Med. 2004;43(5):605-625. [PubMed]
Jagoda A, Gupta K. The emergency department evaluation of the adult patient who presents with a first-time seizure. Emerg Med Clin North Am. 2011;29(1):41-49. [PubMed]