PV card: PE Severity Index (PESI) score
Do you send some of your low-risk patients with pulmonary embolism home? This is a controversial issue which warrants a look at risk stratification tools. The primary one used is the validated Pulmonary Embolism Severity Index (PESI) score. In Lancet 2011, the authors looked at whether PESI class I and II (low risk) patients could be managed safely as outpatients. It turns out in their study, regardless of whether their PESI class I and II patients were treated as outpatients and inpatients, all fared equally well from a complications standpoint (recurrent clot, bleeding from anticoagulation). I like the validated PESI [+]
Take the quiz: Do you know your antihypertensive agents?
Identify the antihypertensive agent: 1. Rapid acting systemic and coronary artery vasodilator with minimal effects on cardiac conductivity or inotropy. Well studied in pregnancy. Caution in patients with left ventricular failure, liver cirrhosis Answer: Nicardipine 2. Predominantly dilates the venous system. Useful in patients with cardiac ischemia, pulmonary edema, or congestive heart failure. Caution in patients with right ventricular failure Answer: Nitroglycerin 3. Drug of choice in eclampsia, pre-eclampsia, and aortic dissection. Contraindicated in patients with congestive heart failure and heart block Answer: Labetalol 4. Decreases peripheral vascular resistance and increases collateral coronary blood flow in an uncontrolled and unpredictable manner and [+]
Trick of the Trade: Searching for Comments to a Published Article
One day back in 2005 during my PGY-1 pharmacy practice residency, I remember a conversation with my residency director. He was a Surgical/Trauma ICU pharmacist. There had been a recent article published (I think it may have been one linking ‘tight’ glucose control to decreased mortality in ICU patients). Funny how times change… Anyway, he mentioned all of the ‘discussion’ surrounding the article in terms of comments submitted to the journal. It was my first introduction to the idea that published literature could be challenged through an avenue provided by the journal. Just this past week during EM residency journal [+]
New video series for med students: The Patwari Academy
Similar to Salman Khan of the Khan Academy, which is famous for “flipping the classroom”, Dr. Rahul Patwari is a one-man innovating machine at Rush University’s Department of Emergency Medicine. He has been creating digital whiteboard “chalktalks” on common EM conditions for the past year, which target the senior medical student. These 2-15 minute videos are way too amazing not share with the EM community of learners. I bet these would be really great supplemental learning material for EM medical students everywhere. [+]
Trick of the Trade: Persistent paracentesis leakage
Dr. Matt Borloz (Carilion Clinic) recently emailed me his recent trick in fixing a persistently leaking paracentesis site. Read about his experience: A patient with advanced alcoholic cirrhosis with ascitic fluid leaking from a paracentesis puncture site from a procedure done 2 days prior. Dermabond had initially been applied post-procedure, but it had come loose, and ascitic fluid had been saturating dressing after dressing. [+]
Mythbuster: Urgent dialysis following IV contrast?
Have you ever had to promise the radiologist that you would arrange emergent dialysis for your end-stage renal disease (ESRD) patient after receiving IV contrast? This myth is even perpetuated in the field of nursing. In fact, what prompted this post was overhearing this very topic discussed between a nurse and a recent graduate nurse trainee. [+]
Trick of the Trade: Universal precautions for your iPad
iPads are increasingly being used in medical education in a variety of arenas, including the classroom, the bedside, and small group workshops. I recently taught in a procedures lab with unembalmed cadavers at UCSF’s new anatomy lab (on the 13th floor of the hospital with spectacular views of San Francisco and the Golden Gate Bridge). Everyone was gowned up from head to toe using universal precautions. But wait, what about my iPad? How can I use it to teach at the “bedside” about arthrocentesis? [+]
Top 10 medical photography tips for a camera phone
A picture is worth a thousand words. My corollary to this statement is that a poorly framed or blurry image significantly detracts from its impactfulness. Plus, it just looks unprofessional. I have had to either retake or Photoshop-edit several photos submitted for blog posts. There have been many amazing photos which I decided not to use because of image quality. [+]
Trick of the Trade: Avoiding a straight-needle needlestick injury
You are finishing up a successful subclavian line procedure. You insert the straight-needle suture needle through the skin to secure the line. When trying to pull it out, you accidentally poke yourself! This is actually a common scenario for a needlestick injury. Although many central line kits now have curved suture needles, many still have straight needles. How can you avoid a needlestick? [+]
PV card: Mnemonics to predict the difficult airway
PV Card: Predictors of a Difficulty Airway See ALiEM (PV) Cards for other resources
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Latest posts by Shuhan He, MD (see all)
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