• Prescription Pad

Trick of the Trade: Prescribing opiates

By |Categories: Tox & Medications, Tricks of the Trade|

  As emergency physicians, we are experts in pain control. We frequently write opiate prescriptions for patients being discharged home. Unfortunately, an occasional patient tries to forge my prescription. At times, I get a call from pharmacy for prescriptions that were suspiciously written. For instance several years ago, I had someone try to forge 100 tablets of “Mophine”. […]

  • Strep

Paucis Verbis card: Strep pharyngitis

By |Categories: ALiEM Cards, ENT, Pediatrics|

Have you heard of the Modified Centor Score for strep pharyngitis? Interestingly, it has been validated in adults and children. The methodology builds on the traditional Centor Score by incorporating the patient’s age, because this disease is more prevalent in kids than adults. In fact, you actually lose a scoring point if you are older than 44 years old. […]

  • Mandible Tongue Blade

Trick of the Trade: A tongue blade is as mighty as an xray

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

Patients often present to the Emergency Department for mandibular blunt trauma. Usually these patients have soft tissue swelling at the point of impact. In mandibular body fractures, the fracture line often extends to the alevolar ridge. This may cause a gap between a pair of lower teeth. In patients with jaw pain, mild swelling, and normal dentition, is there a way to avoid imaging these patients to rule-out a mandible fracture? […]

  • Laryngoscope

Paucis Verbis card: Rapid Sequence Intubation

By |Categories: ALiEM Cards, Tox & Medications|Tags: |

The key to success in performing procedures is preparation. This is especially true for endotracheal intubations in the Emergency Department where things are chaotic. Strategic planning and anticipation of obstacles during rapid sequence intubation (RSI) are key principles to avoiding complications. […]

  • OKN drum

Trick of the Trade: OKN drum to test psychogenic coma

By |Categories: Neurology, Tricks of the Trade|

Occasionally, emergency physicians see patients who present because they are unresponsive despite normal vital signs and an otherwise normal exam. You detect no drugs or alcohol on board. You suspect a psychiatric or malingering etiology, but aren’t sure. They seem non-responsive to voice and minimally responsive to very painful stimuli. Is this a case of psychogenic coma or true coma (with bilateral hemispheric dysfunction)? What test can you do to reassure yourself that this may indeed be psychogenic coma? […]

  • Knife holder

Paucis Verbis card: Penetrating abdominal trauma

By |Categories: ALiEM Cards, Trauma|

When I did my residency training in Emergency Medicine and in the first few years as an attending, we regularly performed diagnostic peritoneal lavages in patients with stab wounds injuries to the abdomen. Patients also routinely went to the operating room for exploration. Now with the evolution of CT imaging technology and more clinical studies, there is now a role for a less invasive management approach. These are the Eastern Association for the Surgery of Trauma (EAST) guidelines. […]

Work NOT in progress: ACEP Tricks of the Trade column

By |Categories: Tricks of the Trade|

Since 2006, I have been the ACEP News columnist on “Tricks of the Trade in Emergency Medicine.” Four years later, I’ve published and co-published 33 articles on various both low-tech and high-tech pearls. It’s official — I’ll be stepping down from the ACEP News columnist position and handing off the reins to someone with fresher ideas. Frankly, I’m running out of innovative ideas worth publishing about. […]