Trick of Trade: Rule of 10’s for burn fluid resuscitation
A patient presents with burns to both his arms, chest, and abdomen (anteriorly only) from a flash fire. That’s about 27% total body surface area (TBSA). So how much IV fluid should be given? Be aware of a phenomenon known as “fluid creep”, where patients actually get WAY too much IV fluids than they should, which can cause delayed complications such as ACS, pulmonary edema, and compartment syndrome. Don’t forget that patients often get a lot of IV fluids in the prehospital setting, which should also be factored in. [+]
Patwari Academy videos: Presenting patients in the ED
Doing well on your Emergency Medicine rotation, whether you are a medical student or resident, will depend in large part on your ability to deliver a coherently concise presentation to the senior resident or attending physician. It’s about telling a story that fits into the construct of how the expert physician thinks. [+]
Trick of the Trade: Reducing the metacarpal neck fracture
General principles of fracture reduction involve axially distracting or pulling on a fracture fragment and pushing the piece back into anatomical alignment. This can be seen in the video below (automatically starts at 2:25 for the actual procedure). What if this approach doesn’t work? The fracture fragment remains immobile despite your best efforts. [+]
Patwari Academy videos: Primary and secondary assessment
Deer in headlights That was me as a medical student, when I first encountered an undifferentiated patient in moderate distress. The trick is to have a standardized primary and secondary survey approach. Sometimes it takes just a little kick-start to get you thinking and doing. [+]
Paucis Verbis: Composition of intravenous fluids
There has been a lot of discussion on the ideal intravenous fluids (IVF) for resuscitation in the Emergency Department and ICU. This was highlighted by the landmark study in JAMA on ICU patients who received chloride-rich versus chloride-restricted IVFs. This got me to thinking, what exactly comprises the common IVFs that we order? We so often take for granted what's in 1 liter of normal saline. As it turns out, normal saline is not really "normal". Dr. Scott Weingart has a great podcast on "chloride poisoning" using IVFs. This PV card helps remind me what's in each liter bag of fluids [+]
P-video: How to remember the GCS scoring
https://www.youtube.com/watch?v=5iOXCrctbzA In this inaugural P-video, Dr. Jeremy Faust gives us a quick way to remember how keep the maximum subscores of the Glasgow Coma Scale (GCS) straight. There's verbal, motor, and eyes. Which has a max score of 4, 5, and 6?
MIA 2012: Smith SW et al. Diagnosis of ST-Elevation Myocardial Infarction in the Presence of Left Bundle Branch Block With the ST-Elevation to S-Wave Ratio in a Modified Sgarbossa Rule. Ann Emerg Med. 2012 Dec;60(6):766-76
Bottom Line [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
MIA 2012: Levy P et al. Subclinical hypertensive heart disease in black patients with elevated blood pressure in an inner-city emergency department. Ann Emerg Med. 2012 Oct;60(4):467-74.e1.
Bottom Line1 In asymptomatic black patients who presented to the ED with elevated blood pressure, subclinical hypertensive heart disease was detected in 9 of every 10 patients. [+]
Director of Growth, Strategic Alliance Initiative, Center [+]
MIA 2012: Canto JG et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012 Feb 22;307(8):813-22.
Bottom Line 1 Chest pain free MI is a very real phenomenon and it is associated with higher mortality – especially in younger women (NRMI study). [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation [+]
MIA 2012: Campagna JD, et al. The use of cephalosporins in penicillin-allergic patients: a literature review. J Emerg Med. 2012 May;42(5):612-20
Bottom Line 1 For patients with penicillin (PCN) allergies, it is safe to administer third- and fourth-generation cephalosporins (CPN) with no fear of cross reaction. Use of first- and second-generation CPN should only be avoided when the penicillin antibiotic shares structurally similar R1 side chains. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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