Paucis Verbis: Lifetime attributable risk of cancer from CT
How great would it be if you could give patients concrete numbers when you are talking about cancer risk and CT? Well, Dr. Hans Rosenberg (Univ of Ottawa) has come up with just such a table. Using this table you can say that the risk is about "one in ..." PV Card: Cancer Risk from CT Adapted from [1] Go to ALiEM (PV) Cards for more resources. Reference Smith-Bindman R. Radiation Dose Associated With Common Computed Tomography Examinations and the Associated Lifetime Attributable Risk of Cancer. Archives of Internal Medicine. 2009;169(22):2078. doi: 10.1001/archinternmed.2009.427
Trick of the Trade: Fingertip injuries
Fingertips can get injured in a variety of ways such as machetes, meat grinders, and broken glass. You name it, and we’ve probably seen it. Some don’t actually need anything invasive done because the skin is basically just torn off. The wound just needs to be irrigated, explored, and then bandaged to allow for secondary wound closure. What do you do if the finger injury keeps oozing and the finger tip is too painful for the patient to apply firm pressure? Poking the finger with 2 needles to perform a digital block seems a bit overkill. [+]
Paucis Verbis: Pulmonary Embolism Clinical Prediction Rules
"Should I get a D-Dimer test or CT chest angiogram on my patient with atypical chest pain to rule-out a pulmonary embolism?" This is a common question asked by emergency physicians on a routine basis. Here are 3 clinical prediction rules: PERC, Wells, and Simplified Geneva Score. Personally, I've never used the Geneva Score, but it's worth looking at. A WORD of CAUTION These rules should be used with caution, because none of these scoring protocols are perfect. For instance, in a recent publication in the Journal of Thrombosis and Haemostasis, the authors found that the PERC rule does not actually [+]
Tricks of the Trade: Tea bags to the rescue
I have heard of using tea bags under your eyes to reduce puffiness, but to combat odors in the ED? In my growing list of “Tricks of the Trade” tips for protecting your olfactory nerves (Antacid booties for toxic sock syndrome, aerosolized orange juice, abscess drainage using suction), I got a clinical gem from Dr. James Juarez (Rogue Valley Medical Center in Ashland, OR) after my recent Tricks of the Trade talk at High Risk EM in San Francisco. [+]
Paucis Verbis: Outpatient treatment for diverticulitis
The classic prior teaching for the treatment of diverticulitis includes: Hospital admission Bowel rest (NPO) IV fluids Broad spectrum IV antibiotics Do ALL patients need to be admitted? There is some early literature suggesting that there is a small sub-population who fare well with outpatient treatment. This article from Annals of EM in the "Best Available Evidence" series summarizes the existing literature well. PV Card: Diverticulitis Adapted from [1] Go to ALiEM (PV) Cards for more resources. Word of caution This paper only provides guidelines, based on the limited evidence out there. Still use your common sense. For instance, I'd [+]
Trick of the Trade: Ring removal from a finger
A patient presents with a swollen finger after falling and fracturing it. The patient is more distraught by the fact that she can’t get the ring off her finger. She implores you not to cut the ring off. There are textbook chapters written about tightly wrapping the digit with string from distal-to-proximal and sliding the string under the ring. Theoretically, the provider can pull and unwind the proximal end of the string to gradually coax the ring over the coils of string. I have personally found little luck with this maneuver. [+]
Paucis Verbis: International Registry on Aortic Dissection (IRAD)
What do these 3 people have in common? Lucille Ball (comedienne) Jonathan Larson (wrote the musical "Rent") John Ritter (comedian) They all died from an aortic dissection. We commonly consider this diagnosis for Emergency Department patients presenting with severe chest pain. There is an International Registry on Aortic Dissection which published a retrospective, descriptive study of 464 patients with dissections. I find this list helpful, because it illustrates the fact that the classic signs and symptoms aren't actually very common. Here are some scary examples: A pulse deficit in the carotid, brachial, and femoral arteries is only present 15% of [+]
Trick of the trade: Improve your ability to detect a cerebellar lesion
The finger-to-nose exam is typically used to detect a cerebellar lesion. In subtle cases though, this can be be difficult to detect. How can you improve your sensitivity of this exam? Trick of the trade: Elbows up! [+]
Paucis Verbis: Head CT clinical decision rules in trauma
The ideal clinical decision tool has a sensitivity and specificity of 100%. You need a high sensitivity to be sure that your negative result indeed predicts a true negative. That means if your clinical decision tool suggests that you don't need to get a head CT, then your head CT would have been normal. On the flip side, this realistically means there is a low-moderate specificity. That means a clinical decision tool with at least 1 positive criterion does not always mean that there will be an abnormal finding on head CT. There are 3 major clinical decision rules that I've [+]
Videos: The EM Eye Exam
Thanks to Dr. David Duong and Dr. Najm Haqu (UCSF) for letting me cross-post their amazing instructional video on the “EM Eye Exam”. These videos were made for the purpose of teaching senior medical students on their UCSF-SFGH EM clerkship. I thought it’d be great to share these tutorials, since the eye exam is typically a daunting task for many medical students (and residents). [+]
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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