Poll: How would manage a metacarpal fracture in the ED?
I am in the process of creating a PV card on metacarpal fractures, divided into anatomical areas (base, shaft, neck, head), and am realizing that the EM and orthopedic literature don’t quite agree. Actually they are quite vague on whether reductions should occur in the ED vs orthopedics clinic in the next few days. Do you need to close-reduce all angulated fractures in the ED, which are outside of “acceptable” angulations? What exactly are “acceptable” angulations? Some sources say that angulations of 10, 20, 30, and 40 degrees are acceptable for MC neck fractures and only 10, 10, 20, and [+]
Trick of the Trade: Ultrasound-guided supraclavicular central line
Subclavian central lines are commonly touted as the central line site least prone to infection and thrombosis. The problem is that they are traditionally performed without ultrasound guidance. They are done blindly because of the transducer’s difficulty in getting a good view with the clavicle in the way. [+]
Patwari Academy videos: ACLS (parts 4-6)
Below are the next 3 video installments of Dr. Rahul Patwari’s digital whiteboard talks on ACLS. These videos cover: Cardiac arrest (Vfib and Vtach) Cardiac arrest (More of Vfib and Vtach) Cardiac arrest (Asystole and PEA) I love that each video is less than 15 minutes long. Also, even if you aren’t a medical student, these are great refreshers. For instance, don’t forget that atropine is no longer on the 2010 ACLS algorithm for asystole. [+]
Trick of the Trade: Sterile cover for linear ultrasound probe
You decide to use ultrasonography to help you establish peripheral IV access for and obtain blood cultures from your patient. How can you ensure that you get a sterile sampling to avoid blood culture contamination? Do you need to open a full central-line ultrasound probe cover? [+]
Losing faith in evidence-based medicine: Etomidate and sepsis
In an era where evidence-based medicine is the goal, it is vitally important for practitioners to understand how to prioritize and interpret the onslaught of data coming at us. This fact was driven home for me with a recent publication. Several weeks ago an article was published in Critical Care Medicine entitled “Etomidate is associated with mortality and adrenal insufficiency in sepsis: A meta-analysis.”The point of this post is not to debate if etomidate should be used to intubate septic patients. Etomidate very well may kill people with sepsis. I just don’t know from the data currently available. Using this meta-analysis [+]
Patwari Academy videos: ACLS and the Airway
This videos below include a 2-minute introductory video on the ACLS video and the first 2 (Airway) of 11 video discussions on different components of ACLS. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and [+]
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. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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