Trick of the Trade: Knee Arthrocentesis

arthrocentesis2A patient comes into the ED and you suspect septic arthritis to the knee. As you consent the patient for arthrocentesis, you can tell s/he has reservations about a needle being inserted into their knee and left in place while you aspirate. You also think in the back of your mind how tricky it is to sometimes change syringes while keeping the needle in the correct location. Is there another way of tapping the knee without a needle?

 

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PV Card: Skin and Soft Tissue Ultrasound

Abscess Ultrasound

We know that ultrasonography can be used to identify soft tissue infections. But what exactly are the distinguishing features between cellulitis and abscess? Is that a foreign body? Should I put a scalpel to this soft tissue infection? This PV card, written by Drs. Alissa Genthon, Patricia Henwood, and Mike Stone, serves as a great reference card for you at the bedside.

PV Card: Skin and Soft Tissue Ultrasound


Go to ALiEM (PV) Cards for more resources.

PV Card: Focused Biliary Assessment Ultrasound

focused biliary assessment ultrasound - cholecystitis

Have trouble finding the common bile duct? What’s the normal thickness of the gallbladder wall? What are common pitfalls in imaging the gallbladder? This is a great Paucis Verbis (PV)/ALiEM card on focused biliary assessment using ultrasound, courtesy of Drs. John Eicken and Mike Stone.

PV Card: Focused Biliary Assessment Ultrasound


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

References

  1. Blaivas M, Harwood R, Lambert M. Decreasing length of stay with emergency ultrasound examination of the gallbladder. Acad Emerg Med. 1999;6(10):1020-1023. [PubMed
  2. Summers S, Scruggs W, Menchine M, et al. A prospective evaluation of emergency department bedside ultrasonography for the detection of acute cholecystitis. Ann Emerg Med. 2010;56(2):114-122. [PubMed]
By |2021-10-06T10:04:43-07:00Jan 1, 2015|ALiEM Cards, Gastrointestinal|

D50 vs D10 for Severe Hypoglycemia in the Emergency Department

d50

Think back to your last severely hypoglycemic and lethargic patient presenting to the ED. What was the first treatment modality that came to mind? The initial knee-jerk reaction might be to reach for that big blue box of D50 if the patient has IV access. After all, top priority is to reverse hypoglycemia as fast as possible. But in the midst of stabilizing the patient, how often do we consider the potential aftermath of concentrated glucose?

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