Trick of Trade: Needle foreign body removal
An IV drug user accidentally breaks off a 25-gauge needle in his/her forearm and presents to your ED for needle foreign body removal. How can you minimize the degree of trauma to the patient? How can you minimize the number of incisions made in order to find and remove this “needle in a haystack”? [+]
Patwari Academy videos: Toxicology
What is your approach to the poisoned patient? Listen to these 4 videos by Dr. Rahul Patwari to build your foundation of knowledge in toxicology. Introduction Toxidromes Testing Decontamination [+]
Director of Growth, Strategic Alliance Initiative, [+]
PV card: VBG versus ABG
You obtain a venous blood gas (VBG) on a patient with a COPD exacerbation because you are concerned about hypercarbia. You get a value of 55 mmHg. How correlative is that compared to an arterial blood gas (ABG). There has been a lot of literature on how well the pH correlates between the ABG and VBG but what about pCO2? A small study (n=89) from 20121 found that with a cutoff of pCO2 < 45 mmHg, the venous pCO2 is 100% sensitive in ruling out arterial hypercarbia. When the pCO2 was ≥ 45 mmHg, the VBG was less correlative. Below is [+]
Patwari Academy videos: Demystifiying how ECGs work
As a nice segue from the Low Risk Chest Pain videos, below is a 3-part series on Demystifying the Electrocardiogram by Dr. Rahul Patwari. It takes talent to make the complex simple. [+]
Director of Growth, [+]
App review: POC Ultrasound Guide
There is a new free app called POC Ultrasound Guide [iTunes link], created by Wexner Medical Center at Ohio State University. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General [+]
PV card: Diagnosis of DVT (ACCP guidelines)
A patient presents with an asymmetric leg with trace pitting edema in the affected leg. What is your diagnostic approach to such a patient? What is the role of D-dimer and ultrasound (U/S)? Does this match the 2012 American College of Chest Physicians (ACCP) guidelines? The first step is to determine your patient's pretest probability because the recommendations vary based on risk. I can tell you that many ED patients come in with a Wells score of 1-2, which places them in the "moderate pretest probability" category. There are 2 approaches you can take based on the availability of resources at [+]
One-dose vancomycin for SSTIs: Just don’t do it
You are managing an otherwise healthy patient with cellulitis but no abscess to poke. You decide this patient needs antibiotics but is stable enough to go home.”Give em’ a dose of vanc before they go,” right? [+]
Trick of Trade: Incision and loop drainage using tourniquet
The technique for abscess drainage traditionally is incision and drainage (I&D). In August 2012, I wrote about incision and loop drainage (I&LD), which it seems has gained popularity over time with similar outcomes. This technique involves using a sterile vascular loop, which is thin and long enough to form a loose knotted loop. The video below by Dr. Rob Orman reviews the steps. But, what if you don’t have a vascular loop in the ED? [+]
Patwari Academy videos: Low risk chest pain
One of the most common complaints in the Emergency Department is chest pain. Is it something serious? How do I risk-stratify patients with potential acute coronary syndrome? What should I be thinking of and not missing? Rahul goes over the low-risk chest pain patient in 2 great, short teaching videos, based partly on the 2010 AHA/ACC Guideline for ACS risk stratification. [+]
P-video: Remembering NEXUS criteria
https://www.youtube.com/watch?v=fUulc4cjH00 [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Latest posts by Shuhan He, MD (see all)
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