• Sgarbossa criteria

Paucis Verbis: Sgarbossa’s Criteria with LBBB

By |Categories: ALiEM Cards, Cardiovascular, ECG|

It is difficult to determine if a patient with a left bundle branch block (LBBB) has an acute myocardial infarction (AMI) because ST segments are “appropriately discordant” with the terminal portion of the QRS. That means if the QRS complex is negative (or downgoing), the ST segment normally will be positive (or elevated). Similarly if the QRS complex is positive (or upgoing), the ST segment will be negative (or depressed). […]

  • Child Cough

Paucis Verbis card: Algorithm for suspected pertussis in pediatrics

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

To treat for pertussis or not? In the setting of the current pertussis epidemic in California, each kid with a cough sparks constant debate about whether to treat with azithromycin or not. Finally, thanks to my friends Dr. Andi Marmor and Dr. Shon Agarwal Jain (UCSF Pediatrics faculty), there’s a great algorithm to help you answer the question. I have found this algorithm extremely helpful. […]

  • atomizer

Tricks of the trade: Intranasal fentanyl for pediatric patients

By |Categories: Pediatrics, Tricks of the Trade|

  Pediatric patients often receive inadequate pain control in the setting of orthopedic injuries. Because the child experiences fear, anxiety, and pain with needles, practitioners often shy away from ordering IV or IM pain medications. Oral agents, while easier to administer, usually provide inadequate pain control. Trick of the Trade Intranasal (IN) fentanyl Thanks to my friend Dr. Ron Dieckmann (Editor-in-Chief for PEMSoft, Chairman of Board for KidsCareEverywhere, and Pediatric Director for Valley Emergency Physicians) for his tip about intranasal fentanyl:It is imperative that the drug be administered in a nebulized form using an atomizer device -- one half the [...]

  • Broselow tape

Paucis Verbis card: Pediatric weight-based reference (5-34 kg)

By |Categories: ALiEM Cards, Pediatrics|

The foundation in any pediatric resuscitation is the length-based estimation of the patient’s lean body weight. Once determined, equipments and medications are sized and dosed, respectively, according to that weight. You can use electronic resources such as PEMSoft (Pediatric Emergency Medicine Software) or the more traditional paper-based Broselow tape. […]

  • BVM placement

Trick of the trade: Face mask ventilation in edentulous patients

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

Can you imagine trying to bag-valve-mask ventilating this patient without teeth? Edentulous patients can cause BVM problems because air tends to leak out the sides of the mouth, because the cheeks don’t contact the mask as well. You can do a jaw-thrust and/or place an oropharyngeal airway to help. What else can you do? […]

  • cervical fractures diagram

Paucis Verbis card: C3-C7 spinal fractures

By |Categories: ALiEM Cards, Orthopedic|

This is the second Paucis Verbis card on cervical spine fractures. Part 1 covered C1 and C2 fractures. This card covers the lower cervical spine fractures. These two tables are part of my chapter on “Spine and Spinal Cord Injury” in the textbook Emergency Medicine by Dr. Jim Adams (Northwestern EM Chair). […]

  • cervical fractures diagram

Paucis Verbis card: C1-C2 injuries

By |Categories: ALiEM Cards, Orthopedic|

I’m starting to work on co-authoring the next edition of my chapter on “Spine and Spinal Cord Injury” within the textbook “Emergency Medicine” by Dr. Jim Adams (Northwestern EM Chair). There are some useful tables that I created that I thought you might find helpful. This is the first installment covering C1-C2 fractures. The next PV card will cover the lower cervical fractures. I always forget which are stable and unstable. For instance, the above extension teardrop fracture looks innocuous but is an unstable fracture because the anterior longitudinal ligament is ruptured. […]