• Journal Club

Trick of the trade: Spicing up your evidence-based lecture

By |Categories: Medical Education, Tricks of the Trade|

Before I start creating a new talk, I ask myself 3 questions: Who will be in the audience? How can I make my talk more worthwhile to audience members, beyond their just reading the material/handout/articles on their own? Am I giving a talk before or after Dr. Amal Mattu? If so, just be resigned to being second-best. […]

iPhone uses in the Emergency Department

By |Categories: Social Media & Tech, Tricks of the Trade|Tags: |

Occasionally, I get a rare – “Hey congrats on the article!” comment from residents or students. It’s usually in reference to my ACEP News column that comes out every 3 months on Tricks of the Trade. However, I got about 3 shout-outs in the past 2 days. How odd. Then I saw one of our office staff who was reading EM News. “Hey cool!” she said. Totally confused, I realized that I was quoted on the front page of this week’s publication about iPhone applications in EM. Many months ago, I had done a brief telephone interview with the writer. [...]

  • penlight

Trick of the Trade: My new penlight

By |Categories: Tricks of the Trade|

On any given day in the ED, I use my super-bright penlight 2-5 times a day. It is amazing what things I’ve almost missed without a bright LED flashlight. Subtle HSV-2 labial ulcerations in a female patient with dysuria Additional scalp lacerations hidden in the hair Tonsillar exudates in a patient with strep pharyngitis Unequal pupillary responses in a brightly lit trauma room in a head-injured patient I wanted to revisit a prior post about the importance of changing your Tungsten penlight to a LED light. […]

  • Tibial Plateau

Beware the hidden tibia plateau fracture

By |Categories: Orthopedic, Radiology|

Find the fracture in this patient with blunt knee trauma. As a general rule, plain films are insensitive in ruling out orthopedic injuries. One particularly tricky area is the knee. This 2-view knee series above is normal. Did you know that the sensitivity of picking up knee fractures is as low as 79% with a 2-view series and 85% with a 4-view series? With the advent of CT imaging, more and more subtle fractures are being found. […]

Paucis Verbis card: Pediatric blunt head injury

By |Categories: ALiEM Cards, Pediatrics, Trauma|

In this installment of the Paucis Verbis (In a Few Words) e-card series, the topic is Pediatric Blunt Head Trauma. This a particularly relevant topic given the recent press and discussions about CT irradiation and the cancer risk especially in pediatric patients. It’s also relevant since Dr. Nate Kuppermann (UC Davis) just gave Grand Rounds at our UCSF-SFGH EM residency program. He first-authored a landmark 2009 Lancet article on minor head injury in kids. […]

  • Dermabond Tape

Trick of the Trade: Preventing tissue adhesive seepage

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

As great as tissue adhesives are in wound closure, they come with some risk. For instance, liquid adhesives, such as Dermabond, can "run" and contact undesired areas such as eyelid margins. Careful application of tissue adhesives is critical. How can you minimize the amount of seepage of tissue adhesive to undesired areas? Trick of the Trade Create an impermeable tape barrier I already mentioned this in an earlier post in July, but I now have more experience with this technique. Here are some recent photos of this trick in action. Cut out a circle from a transparent tape adhesive. In [...]

  • 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). […]