A 40 year-old man presents with a traumatic hemopneumothorax. He weighs 400 pounds.
Chest tubes can sometimes be challenge, especially for those with extra redundant tissue to tunnel through before reaching the intrathoracic cavity. You want to avoid placing the chest tube mistakenly in the subcutaneous space. How can you ensure that your chest tube actually reaches the intrathoracic space?
A reader, Mark, posted a question yesterday in the chat box about screencapture softwares out there. I personally use iShowU to capture such videos as my instructional video on linking your Evernote account (above) to automatically read and download my weekly public Paucis Verbis notebook. Mark also specifically asked about what Dr. Rob Rogers (Univ of Maryland) uses.
A 25 year old woman presents with palpitations, sweating, and shortness of breath since this morning. 6 days ago she had syncopized, was shocked out of V-tach by EMS, and eventually had a defibrillator placed for an unknown arrhythmia. Now, she feels her heart beating in her chest, looks diaphoretic, is tachypnic, but her pulse is 58 and regular.
Sometimes on off-service morning table rounds, I like to close my tired eyes and focus my ears past the voice of the attending to hear the chorus of hundreds of pieces of paper flipping, shuffling, crinkling, and folding. It’s one way to pass the time when surgeons debate over issues they don’t already know the answers to. Another is to get your phone out, and help answer the questions with them.
A sister and brother, aged 7 and 14, respectively present with pharyngitis. The 7F has sore throat, cough, fever, and post-tussive vomiting for 1 day. She has posterior pharyngeal erythema, no lymphadenopathy, no exudate, no petechiae, and looks like a viral URI.
The 14M had culture confirmed GAS pharyngitis 3 weeks ago, was treated with PCN-VK and symptoms resolved. Now, he’s in the ED with signs and symptoms of pharyngitis again, including dysphagia, fever, cough, posterior pharyngeal erythema, swollen tonsils, LAD, and petechiae on his hard palate.
Last month, I announced Dr. Timothy Peck (Beth Israel Deaconess EM resident) as one of the winners of the Blog Incubator Contest. Starting today and for the next 2 Mondays, he’ll be posting a 3-part series, which will eventually end up on his blog “Modern EM” at ModernEM.blogspot.com. His blog will feature examples of how Web 2.0 influenced the management of specific patient encounters. Also guests will be allowed to contribute mini-case presentations where they will report how a Web 2.0 activity changed how they managed a patient.
The blog is still in development phase. In the meantime, you are in for a treat. His upcoming blog entries are great examples demonstrating the impact of online and app-based clinical decision support tools in the ED.
Let’s welcome Tim to the blogging community!