Trick of the Trade: Finding the femoral vein by V-technique
I rarely access the femoral vein for central venous catheterization… except in medical or trauma resuscitations. Oftentimes in these resuscitations, there are too many people near the IJ or subclavian vein site. People are intubating, performing CPR, trying to get peripheral vein access, etc. [+]
PV Card: Dermatomal and Myotomal Maps
There are some things in life which I just can't memorize and dermatomal/myotomal maps are one of them. Weird cases of peripheral neurologic symptoms have presented to the ED in the setting of trauma and no trauma. So purely for selfish reasons, I'm making my own map to have on file. This installment of the Paucis Verbis (In a Few Words) e-card series reviews Sensory and Motor Function Testing by Levels. PV Card: Dermatomal and Myotomal Maps Go to ALiEM (PV) Cards for more resources.
Trick of the trade: Endotracheal tube lubrication
Does your endotracheal tube get caught up on a swollen or floppy epiglottis during insertion? Trick of the Trade: Endotracheal tube lubrication Occasionally the endotracheal tube may become “caught up” along the epiglottis. Because it is difficult to predict when this may happen, pre-lubricate the endotracheal tube cuff and tip with a thin layer of water-soluble lubricant, such as K-Y jelly. This lubricant can also minimize the degree of surface trauma to the trachea and tracheal rings as the tube passes the vocal cords.
Paucis Verbis card: Ottawa knee, ankle, and foot rules
Often times, I get called to triage to help decide whether a patient should be sent to Radiology for an initial x-ray after injuring their knee, ankle, and/or foot. After teaching one of the nurses about the Ottawa rules, she taped a list of these rules on the triage wall. This installment of the Paucis Verbis (In a Few Words) e-card series reviews Ottawa Knee, Ankle, and Foot Rules. [+]
Trick of the trade: Percuss the spine in low back pain
Many patients present to the Emergency Department for low back pain. Determining whether these patients have a red-flag diagnosis can be difficult. Red flag diagnoses include: Fracture Cauda equina syndrome/ spinal cord compression Spinal infection Vertebral malignancy Almost all patients presenting with back pain, whether it be a muscle spasm or a spinal epidural abscess, will have back tenderness to some extent. So, how can you better differentiate benign from dangerous etiologies? [+]
Paucis Verbis card: Vasopressors and Inotropes for Shock
The treatment of shock should focus on correcting the underlying pathophysiology. With persistent hemodynamic instability, a vasopressor and/or inotrope should be selected. Reviewing receptor physiology can help you select the best-fit agent for the patient's clinical condition. There is an especially useful table on medication selection in the reviewed 2008 EM Clinics of North America article. This installment of the Paucis Verbis (In a Few Words) e-card series reviews Vasopressors and Inotropes for the Treatment of Shock. PV Card: Vasopressors and Inotropes in Shock Adapted from [1] Go to ALiEM (PV) Cards for more resources. Edit 3/28/14: Dopamine removed as [+]
Trick of the Trade: Radial Gutter Splint
How do you splint 2nd or 3rd metacarpal fractures? A short arm volar splint is usually applied, because a fracture should be immobilized one joint distal and proximal to the injury. This splint, however, unnecessarily immobilizes the 4th and 5th fingers. It makes gripping things with your hand difficult. [+]
Paucis Verbis card: Skipping the CT prior to LP for meningitis
With increasing awareness of CT’s irradiation risk, I thought I would review a classic 2001 article from the New England Journal of Medicine. Head CT’s previously were commonly performed prior to all lumbar punctures (LP) to rule-out meningitis. When can you safely go straight to an LP without imaging? Caveat: This review only applies to those patients in whom you suspect meningitis. This does not apply to those being worked up for subarachnoid hemorrhage. [+]
Trick of the Trade: A "handy" ruler
How long is this neck laceration? In the Emergency Department, it is important to be able to accurately estimate the length of wounds, abscesses, and cellulitis. Additionally, billing for wound closure is directly related to the length of the laceration. [+]
Paucis Verbis card: Early goal directed therapy
One of the landmark studies in sepsis was conducted by Dr. Emanuel Rivers (Henry Ford) and published in the New England Journal of Medicine in 2001. By managing patients with severe sepsis and septic shock with an "early goal directed therapy" approach, there was an absolute risk reduction of 16%. Furthermore, the number needed to treat to save a life was 6 patients! This installment of the Paucis Verbis (In a Few Words) e-card series reviews Early Goal Directed Therapy algorithm. The layout is borrowed from a Cleveland Clinic Foundation (CCF) flowchart. Adapted from [1] Go to ALiEM (PV) Cards [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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