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.

(more…)

By Michelle Lin, MD|2016-11-11T19:01:44-08:00Jan 6, 2010|Orthopedic, 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.

<span data-mce-type="bookmark" style="display: inline-block; width: 0px; overflow: hidden; line-height: 0;" class="mce_SELRES_start"></span>
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 I constantly get requests for a copy of them, but they are fairly outdated now that I’m out of residency.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

<span data-mce-type="bookmark" style="display: inline-block; width: 0px; overflow: hidden; line-height: 0;" class="mce_SELRES_start"></span>
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|

Tricks of the Trade: Diagnosing retinal detachment with ultrasound

In a sneak peek of my ACEP News’ Tricks of the Trade column, Dr. Patrick Lenaghan, Dr. Ralph Wang, and I will discuss how bedside ultrasonography can significantly improve your ocular exam.

Here is a classic example. A patient presents with acute onset right eye pain and blurry vision. She possibly has a field cut in her vision. Her pupils are a teeny 2 mm in size in the brightly-lit Emergency Department. You are having a hard time getting a good fundoscopic exam to comfortably rule-out a retinal detachment.

(more…)

By Michelle Lin, MD|2019-01-28T23:53:04-08:00Dec 9, 2009|Ophthalmology, Tricks of the Trade, Ultrasound|

Article review: Neuro exam documentation

Medicolegal woes often can be tracked back to poor documentation by the physician.

This article is a retrospective chart review of 384 EM resident charts, focusing on the documentation of the neurologic exam. Charts were selected if their chief complaints were neurologic or psychiatric in nature. A non-validated measurement tool for evaluating a neurologic exam was created based on discussions with attending emergency physicians. I have to agree with the chosen criteria. Documentation in each of the following criterion receives 1 point for a maximum score of 8.

(more…)

By Michelle Lin, MD|2013-06-27T13:54:49-07:00Dec 7, 2009|Education Articles, Medical Education, Neurology|

A radiology pearl: A subtle orthopedic diagnosis

A man recently presents with knee pain after pivoting and torquing his knee while falling. He complains of concurrent mild ankle pain. He presents with this tib-fib xray. Realizing that a proximal fibular fracture can present concurrently with a medial malleolus fracture or deltoid ligament rupture, we obtained xrays of the ankle. We were looking for a Maisonneuve fracture.

Do you see an ankle injury in these four images?

(more…)

By Michelle Lin, MD|2016-11-11T19:01:52-08:00Nov 13, 2009|Orthopedic, Radiology|

Trick of the Trade: Easy ocular application of fluoroscein

Gently instilling a fluorescein drop into a patient’s eye requires that the patient keep his/her eye still. What do you do for a patient who can’t quite stay still enough, such as an infant? This is an innovative trick of the trade, written by Dr. Sam Ko (Loma Linda EM resident) and Kimberly Chan (Loma Linda medical student).

(more…)

By Michelle Lin, MD|2016-11-11T19:01:53-08:00Nov 4, 2009|Ophthalmology, Tricks of the Trade|