• IJ ultrasound

Article review: Long axis view for IJ line placement

By |Categories: Ultrasound|Tags: |

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). […]

Trick of the trade: Irrigating scalp lacerations

By |Categories: Tricks of the Trade|Tags: |

Thanks to my new-found Emergency Medicine friend in Turkey, Dr. John Fowler has some useful tips about scalp lacerations. Often patients with scalp lacerations have clotted blood in their hair. While we can irrigate the wound itself (and unavoidably soaking the patient in cold irrigation fluid), a lot of blood remains stuck in their hair. It would be nice if we could completely wash out the blood. This would further allows us to detect occult scalp lacerations. […]

  • Kerato conjunctivitis

Paucis verbis card: The Red Eye

By |Categories: ALiEM Cards, Ophthalmology|

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 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 the ALiEM Cards site for more resources.

Trick of the Trade: Modified hair apposition technique

By |Categories: Trauma, Tricks of the Trade|Tags: |

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. […]

Paucis Verbis card: Supratherapeutic INR

By |Categories: ALiEM Cards, Heme-Oncology, Tox & Medications|

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 [...]

  • Iphone Ped Fixation

Trick of the Trade: Pediatric Distractors

By |Categories: Pediatrics, Tricks of the Trade|

Remember back in the day when we made simple toys for pediatric patients to focus on during the physical exam? Remember the inflated medical glove +/- a face drawn on it? I just encountered a FREE iPhone application (Eye Handbook), which has a lot of useful features. I currently only use the Pediatric Fixation animations. They can be found under the “Testing” section. Kids (and often adults too!) become mesmerized and distracted by the cartoon animations. […]

  • Fingernail Lac

Trick of the Trade: Finger nailbed laceration repair

By |Categories: Orthopedic, Tricks of the Trade|Tags: |

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. […]

  • Hip flexion strength testing

Trick of the Trade: Hip flexion strength testing

By |Categories: Tricks of the Trade|

Testing lower extremity strength is a crucial part of the examination in patients with low back pain. In Emergency Departments, however, some patients provide a suboptimal effort because of general fatigue or malingering. How can you differentiate whether asymmetric hip flexion weakness is from suboptimal effort or true weakness? […]

Paucis Verbis Card: CNS Infections

By |Categories: ALiEM Cards, Infectious Disease, Neurology|

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.   Adapted from 1 Go to the ALiEM Cards site for more resources. 1. Somand D, Meurer W. Central nervous system infections. Emerg Med Clin North Am. 2009;27(1):89-100, ix. [PubMed]