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|2021-10-18T10:14:01-07:00Aug 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|

Paucis Verbis card: Urine Toxicology Screen

In the Emergency Department, we often order urine toxicology screens for patients with altered mental status without an obvious cause. I find that patients are often rather forthcoming about their drug use, if they are alert enough to talk. In those cases, ordering a urine toxicology screen is unnecessary.

When you do order a tox screen, however, how do you interpret the information? While the result is a binary answer (positive vs negative), there are some nuances to interpretation. For instance, how long does a patient with urine toxicology remain positive for the drugs? Are there any medications that can cause false positives? See the helpful table below from a great review article in American Family Physician.

Check out what your laboratory screens for and, more importantly, what it does NOT screen for. Our lab, for example, does not screen for PCP but does screen for MDMA (ecstacy). That isn’t a big deal, since patients who ingest PCP aren’t too hard to detect clinically. They have crazy vertical nystagmus, and often there are at least 6 police officers trying to restrain the yelling patient.

PV Card: Urine Toxicology Screen

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

Reference

Standridge J, Adams S, Zotos A. Urine drug screening: a valuable office procedure. Am Fam Physician. 2010;81(5):635-640. [PubMed]

By Michelle Lin, MD|2021-10-18T10:17:50-07:00Jul 23, 2010|ALiEM Cards, Tox & Medications|

Trick of the Trade: A tongue blade is as mighty as an xray

Patients often present to the Emergency Department for mandibular blunt trauma. Usually these patients have soft tissue swelling at the point of impact. In mandibular body fractures, the fracture line often extends to the alevolar ridge. This may cause a gap between a pair of lower teeth.

In patients with jaw pain, mild swelling, and normal dentition, is there a way to avoid imaging these patients to rule-out a mandible fracture?

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By Michelle Lin, MD|2016-11-11T19:00:37-08:00Jul 21, 2010|ENT, Tricks of the Trade|

Paucis Verbis card: Rapid Sequence Intubation

The key to success in performing procedures is preparation. This is especially true for endotracheal intubations in the Emergency Department where things are chaotic. Strategic planning and anticipation of obstacles during rapid sequence intubation (RSI) are key principles to avoiding complications.

PV Card: Rapid Sequence Intubation

Go to ALiEM (PV) Cards for more resources.

By Demian Szyld, MD EdM|2021-10-18T10:19:45-07:00Jul 16, 2010|ALiEM Cards, Tox & Medications|

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