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|

Paucis Verbis card: Hyperkalemia management

Hyperkalemia is a common presentation in the Emergency Department, especially in the setting of acute renal failure. In one shift, I had 4 patients with hyperkalemia! All had from some form of renal failure.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews the treatment options for hyperkalemia.

PV Card: Hyperkalemia

Reference

Weisberg L. Management of severe hyperkalemia. Crit Care Med. 2008;36(12):3246-3251. [PubMed]

By Michelle Lin, MD|2021-10-19T19:04:37-07:00Mar 12, 2010|ALiEM Cards, Endocrine-Metabolic|

Paucis Verbis card: Aneurysmal subarachnoid hemorrhage

Atraumatic subarachnoid bleeds are most commonly caused by ruptured intracranial aneurysms.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews the current management, knowledge, and challenges in aneurysmal subarachnoid hemorrhage (SAH).

PV Card: Subarachnoid Hemorrhage

Reference

Edlow J, Malek A, Ogilvy C. Aneurysmal subarachnoid hemorrhage: update for emergency physicians. J Emerg Med. 2008;34(3):237-251. [PubMed]

By Michelle Lin, MD|2021-10-19T19:03:54-07:00Mar 5, 2010|ALiEM Cards, Neurology|

Using the slit lamp can be a challenge to learn, especially if you haven’t seen pathology before. In checking for anterior uveitis (i.e. iritis), you need to look for “cell and flare”. In theory, you know that you are looking for inflammatory cells and “flare”, which resembles a light beam being filtered through smoke.

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By Michelle Lin, MD|2019-01-30T11:38:44-08:00Mar 2, 2010|Ophthalmology|

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