• Pen for scale

Top 10 medical photography tips for a camera phone

By |Categories: Tricks of the Trade|

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. [+]

  • Straight Needle

Trick of the Trade: Avoiding a straight-needle needlestick injury

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

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? [+]

Best place to suffer a cardiac arrest?

By |Categories: Cardiovascular|Tags: |

Where's the best place to suffer cardiac arrest? Seattle? Las Vegas? Who's going to give me mouth-to-mouth resuscitation? Will someone know how to use an automatic external defibrillator (AED)? Where is the BEST place to experience a cardiac arrest??? As luck would have it, the best place would be at the ACEP Scientific Assembly. On the first day of Scientific Assembly, an exhibitor collapsed in the convention center without a pulse. At a conference with thousands of emergency physicians, several Good Samaritans immediately sprung into action. An attendee used a CPR mask while another operated an AED. They were able [+]

  • Irrigation High Pressure

Trick of the Trade: High volume irrigation of abscesses

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

Large-sized abscess often have pus trapped in deep crevices and pockets. Irrigation can help express the pus. How can you set up a high-volume irrigation system?   [+]

Shuhan He, MD
ALiEM Senior Systems Engineer;
Director of Growth, Strategic Alliance Initiative, Center for Innovation [+]

Trick of the Trade: IV ceftriaxone for gonorrhea

By |Categories: Infectious Disease, Tox & Medications, Tricks of the Trade|

How many times have you given your patient IM ceftriaxone for that presumed gonococcal infection? ... still counting? Many of us learned (or at least thought we learned) that ceftriaxone has to be administered IM to get the ‘depot’ effect. Myth Busted There doesn't appear to be a true depot effect. IV and IM ceftriaxone have very similar pharmacokinetic profiles. Let me prove it to you, straight from the FDA-approved ceftriaxone package insert. Ceftriaxone route 0.5 hr 1 hr 2 hr 4 hr 6 hr 8 hr 12 hr 16 hr 24 hr IV 82 59 48 37 29 [+]

  • Central Line Kit Angiocath

Trick of the Trade: Don’t miss the pneumothorax in needle thoracostomy

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

A patient arrives in PEA arrest and you note that her left chest has no breath sounds or lung sliding on bedside ultrasound. You suspect a tension pneumothorax. You insert a standard 14g angiocather in the left 2nd intercostal space (ICS). You don’t hear a rush of air. The patient’s clinical condition deteriorates to impending asystole. How sure are you that your angiocatheter actually reached the pleural space? [+]

PV Card: Electrolytes and ECG changes

By |Categories: ALiEM Cards, ECG, Endocrine-Metabolic|

The electrocardiogram can pick up all sorts of electrolyte abnormalities. The most common abnormalities revolve around high and low levels of potassium and calcium. Magnesium derangements typically have nonspecific findings. How do you keep things straight? To make things more complicated, multiple electrolyte derangements can occur at the same time, making ECG interpretation challenging. [+]

Shuhan He, MD
ALiEM Senior Systems Engineer;
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Shuhan He, MD