Trick of the Trade: A flexible pediatric ear curette
Having you had trouble seeing a pediatric patient’s tympanic membrane because of impacted cerumen? Scared from that last time you used a rigid curette and caused bleeding in the ear canal? The parents are worried that you hit the brain… [+]
Paucis Verbis: EMTALA rules in the transfer of ED patients
In U.S. academic emergency departments, decisions to accept patients is typically easy, because you have ready access to on-call physicians. When in doubt, accept transfer patients and sort things out later. What are the obligations for those transferring patients to other EDs? What do the EMTALA (a.k.a. "anti-dumping") rules say? When can you transfer unstable patients? As a general rule, the liability falls upon the transferring site and physician. So be sure that your patient won't decompensate in the ambulance during transfer. So, don't transfer that CP patient who is getting ruled-out for an MI or ACS no matter how good [+]
Tricks of the Trade: Calcium gel for hydrofluoric acid burns
A 41 y/o m presents to your ED after an occupational exposure to 30% hydrofluoric acid (HF). The thumb and index finger of his right hand were affected. Upon visual examination, the site of exposure looks relatively benign but the patient is complaining of extreme pain. Beyond giving opioids, what can you do? [+]
Trick of the Trade: Pass the mayo – getting off black tar
Industrial accidents sometimes involve hot coal tar stuck to a patient’s skin. Coal tar is notoriously challenging to remove once it has cooled and adhered to the skin. The tradition teaching is to apply large quantities of petroleum jelly to the black tar, let it sit for at least 60 minutes, and then diligently try to rub away the tar. Repeat as needed. What if you don’t have any petroleum jelly or petroleum-based products? [+]
Paucis Verbis: Delayed sequence intubation
A 40-year-old man presents with significant agitation and severe respiratory distress from a COPD exacerbation. His oxygen saturation is 75% on room air, and he has diffuse, tight wheezes on exam. You prepare to intubate the patient using a rapid sequence induction protocol: etomidate, succinylcholine, 8-0 endotracheal tube. Or do you? This pocket card discusses the delayed sequence intubation (DSI) protocol made famous by Dr. Scott Weingart and Dr. Rich Levitan.1 Thanks to Dr. Michelle Reina (EM resident at Univ of Utah) and Dr. Rob (Intermountain Medical Center in Utah) for designing this helpful card. Rob has even implemented a DSI protocol in [+]
Trick of the Trade: Oral naloxone for opioid-induced constipation
Opioids are amazingly effective for pain control. Patients on chronic opioids, however, often struggle with constipation. These patients may fail supportive treatment with enemas and laxatives. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation [+]
Peeing into the wind? Urine drug screens, part 2 (opiates)
Apart from benzodiazepines, the opiate urine drug screens (UDS) are probably the most frequently utilized and misunderstood. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Paucis Verbis: CHF likelihood ratios
A 50 y/o man with a history of CHF and COPD is brought in by ambulance in severe respiratory distress. He is sitting upright with a RR 30 and O2 saturation of 79% on room air. Is this a CHF or COPD exacerbation? This is a common dilemma faced in the ED. Fortunately there are likelihood ratios to help you risk stratify using a Fagan nomogram. Note that there are 3 tables: All-comer Emergency Department (ED) patients1 ED patients WITH a known history of asthma or COPD2 Summative LRs for BNP are provided in ED patients with or without a history of asthma/COPD1 [+]
Trick of the Trade: Alternative to Word catheter for Bartholin abscess
Bartholin abscesses are challenging to manage, partly because of Word catheter insertion. Sometimes, the space is not large enough (unable to fit the catheter) or too large (catheter falls out). How else can you “pack” the abscess space? [+]
Peeing into the wind? Urine drug screens, part 1 (benzodiazepines)
Let’s be honest. When was the last time results from urine drug screens (UDS) changed your management plan? Many times it takes hours for the patient to give the urine sample anyway. And, with all of the false positives out there, how do we know what the heck the result is actually telling us? [+]
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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- A Tale of Two Epidemics: COVID-19 and the Opioid Crisis - April 23, 2020