Paucis Verbis card: Pediatric blunt head injury

In this installment of the Paucis Verbis (In a Few Words) e-card series, the topic is Pediatric Blunt Head Trauma.

This a particularly relevant topic given the recent press and discussions about CT irradiation and the cancer risk especially in pediatric patients. It’s also relevant since Dr. Nate Kuppermann (UC Davis) just gave Grand Rounds at our UCSF-SFGH EM residency program. He first-authored a landmark 2009 Lancet article on minor head injury in kids.

PV Card: Pediatric Blunt Head Trauma

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

Update June 27, 2017

We collaborated with PECARN and CanadiEM to create visual PECARN’s official decision tool.

Reference

Kuppermann N, Holmes J, Dayan P, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160-1170. [PubMed]

By Michelle Lin, MD|2021-10-19T19:12:36-07:00Feb 5, 2010|ALiEM Cards, Pediatrics, Trauma|

Article review: Long axis view for IJ line placement

As bedside ultrasonography is becoming a staple in central line placement (especially of internal jugular lines), emergency physicians now can minimize complications, such as carotid artery puncture and a pneumothorax. Traditionally, the US probe is positioned along the short-axis of the IJ during the procedure (see right).

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By Michelle Lin, MD|2016-11-11T19:01:39-08:00Feb 1, 2010|Ultrasound|

Paucis verbis card: The Red Eye

Here is another installment of the Paucis Verbis (In a Few Words) e-card series on the topic of The Red Eye from EM Clinics of North America, Here are some sample images:

Epidemic keratoconjunctivitis (note subtle white precipitates over pupil)

Bacterial conjunctivitis (note injection along inferior fornix)

Episcleritis

Scleritis (note bluish hue of deep scleral vessels)

Acute angle closure glaucoma (note corneal edema)

PV Card: The Red Eye

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-19T19:14:54-07:00Jan 22, 2010|ALiEM Cards, Ophthalmology|

I got a nice email from Dr. John Fowler from Turkey who recently published a modified version of the Hair Apposition Technique (HAT) trick in the American Journal of Emergency Medicine in 2009.

Read more about the traditional HAT trick.

The HAT trick allows for scalp laceration closure by using scalp hair and tissue adhesive glue. Contraindications to this technique for wound closure include hair strands less than 3 cm, because it is difficult to manually manipulate short hair.

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By Michelle Lin, MD|2019-11-29T19:03:44-08:00Jan 20, 2010|Trauma, Tricks of the Trade|

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

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

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|

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