Paucis Verbis card: Knee exam

By |Categories: ALiEM Cards, Orthopedic|

How accurate is the clinical knee exam? JAMA published a meta-analysis trying to answer this question. Although they include patients with acute and chronic knee pain, it's a good general review of the knee anatomy, historical clues, and exam elements. In the ED, the knee exam is challenging because we see very acute injuries where knee pain and swelling often preclude an accurate exam. For patients with an equivocal exam, be sure to refer for orthopedic follow-up. A repeat exam should be performed once the pain and swelling subside. This installment of the Paucis Verbis (In a Few Words) e-card [+]

  • Injection

Tricks of the trade: Chemical sedation options

By |Categories: Tricks of the Trade|

 You walk into a room where a patient is screaming and thrashing about in his/her gurney from some stimulant abuse. PCP, cocaine, methamphetamine… or all of the above. When the number of people (police officers, security guards, nurses) is greater than the patient’s pupil size, you KNOW that you’ll need some chemical sedation. What intramuscular sedation regimen do you use? [+]

Paucis Verbis card: Hyperkalemia management

By |Categories: ALiEM Cards, Endocrine-Metabolic|

Hyperkalemia is a common presentation in the Emergency Department, especially in the setting of acute renal failure. In one shift, I had 4 patients with hyperkalemia! All had from some form of renal failure. This installment of the Paucis Verbis (In a Few Words) e-card series reviews the treatment options for hyperkalemia. PV Card: Hyperkalemia  Adapted from [1] Go to ALiEM (PV) Cards for more resources. Reference Weisberg L. Management of severe hyperkalemia. Crit Care Med. 2008;36(12):3246-3251. [PubMed]

  • CT SAH

Paucis Verbis card: Aneurysmal subarachnoid hemorrhage

By |Categories: ALiEM Cards, Neurology|

Atraumatic subarachnoid bleeds are most commonly caused by ruptured intracranial aneurysms. This installment of the Paucis Verbis (In a Few Words) e-card series reviews the current management, knowledge, and challenges in aneurysmal subarachnoid hemorrhage (SAH). PV Card: Subarachnoid Hemorrhage  Adapted from [1] Go to ALiEM (PV) Cards for more resources. Reference Edlow J, Malek A, Ogilvy C. Aneurysmal subarachnoid hemorrhage: update for emergency physicians. J Emerg Med. 2008;34(3):237-251. [PubMed]

Trick of the trade: Irrigation scalp wound photos

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

I mentioned from an earlier post about building a "head basin" for collecting irrigation fluid prior to wound closure. This basin prevents a deluge of fluid from soaking the gurney sheets and patient. I finally managed to capture this trick in action, while a student was irrigating an eyebrow laceration. Pearl When cutting out a semi-circular or rectangular hole in the basin, be sure that there remains a 2-4 inch lip at the bottom to ensure that fluid can collect in the basin.

  • Slit Lamp

Great teaching video: Cell and flare

By |Categories: Ophthalmology|Tags: |

Using the slit lamp can be a challenge to learn, especially if you haven’t seen pathology before. In checking for anterior uveitis (i.e. iritis), you need to look for “cell and flare”. In theory, you know that you are looking for inflammatory cells and “flare”, which resembles a light beam being filtered through smoke. [+]

Paucis Verbis card: NIH Stroke Scale

By |Categories: ALiEM Cards, Neurology|

Patients present with acute strokes to the Emergency Department. Time is of the essence to obtain a rapid neurologic exam, draw labs, get CT imaging, and consulting a neurologist especially if the patient presents within 3 hours of onset. To help the neurologist determine whether the patient should get thrombolytics, calculating a NIH Stroke Scale score is useful.w In this installment of the Paucis Verbis (In a Few Words) e-card series, here is the NIHSS scoresheet. Score 0 No stroke Score 1-4 Minor stroke Score 5-15 Moderate stroke Score 16-20 Moderate-severe stroke Score 21+ Severe stroke PV Card: NIH Stroke [+]

  • 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. [+]

  • Ankle Injury

Paucis Verbis card: Ankle fractures

By |Categories: ALiEM Cards, Orthopedic, Radiology|

Ankle fractures are a common injury diagnosed in the Emergency Department. Being able to speak Ortho-ese (i.e. the language of orthopedists) is invaluable in consulting the orthopedist over the phone. One ankle fracture classification system that our orthopedists like to use is the Lauge-Hansen system. PV Card: Lauge-Hansen Classification of Ankle Fractures Go to ALiEM (PV) Cards for more resources.