Tricks of the trade: Intranasal fentanyl for pediatric patients
Pediatric patients often receive inadequate pain control in the setting of orthopedic injuries. Because the child experiences fear, anxiety, and pain with needles, practitioners often shy away from ordering IV or IM pain medications. Oral agents, while easier to administer, usually provide inadequate pain control. Trick of the Trade Intranasal (IN) fentanyl Thanks to my friend Dr. Ron Dieckmann (Editor-in-Chief for PEMSoft, Chairman of Board for KidsCareEverywhere, and Pediatric Director for Valley Emergency Physicians) for his tip about intranasal fentanyl:It is imperative that the drug be administered in a nebulized form using an atomizer device -- one half the [+]
Paucis Verbis card: Pediatric weight-based reference (5-34 kg)
The foundation in any pediatric resuscitation is the length-based estimation of the patient's lean body weight. Once determined, equipments and medications are sized and dosed, respectively, according to that weight. You can use electronic resources such as PEMSoft (Pediatric Emergency Medicine Software) or the more traditional paper-based Broselow tape. If you have neither of these at your easy disposal, I thought I would create a multi-card reference which works best in electronic pdf form on your mobile device. Even if you DO have other available references, it's still nice to have some redundant back-up sources just in case. This data [+]
Trick of the trade: Face mask ventilation in edentulous patients
Can you imagine trying to bag-valve-mask ventilating this patient without teeth? Edentulous patients can cause BVM problems because air tends to leak out the sides of the mouth, because the cheeks don’t contact the mask as well. You can do a jaw-thrust and/or place an oropharyngeal airway to help. What else can you do? [+]
Retinal detachment on ultrasound
I just wanted to revisit the Trick of using bedside ultrasonography to diagnose retinal detachments. Be sure to use plenty of ultrasound gel and use the linear tranducer. [+]
Director of Growth, Strategic Alliance Initiative, Center for [+]
Paucis Verbis card: C3-C7 spinal fractures
This is the second Paucis Verbis card on cervical spine fractures. Part 1 covered C1 and C2 fractures. This card covers the lower cervical spine fractures. These two tables are part of my chapter on "Spine and Spinal Cord Injury" in the textbook Emergency Medicine by Dr. Jim Adams (Northwestern EM Chair). PV Card: C3-C7 Fractures and Injuries Go to ALiEM (PV) Cards for more resources.
Trick of the trade: Discounted medications at pharmacies
Many times, patients who we deem as “noncompliant” with medications may actually be financially unable to afford medications that we prescribe them. Thanks to Amy Kinard, I just learned about this great new website where you can find pharmacies with amazing discounts for common medications. [+]
Paucis Verbis card: C1-C2 injuries
I'm starting to work on co-authoring the next edition of my chapter on "Spine and Spinal Cord Injury" within the textbook "Emergency Medicine" by Dr. Jim Adams (Northwestern EM Chair). There are some useful tables that I created that I thought you might find helpful. This is the first installment covering C1-C2 fractures. The next PV card will cover the lower cervical fractures. I always forget which are stable and unstable. For instance, the above extension teardrop fracture looks innocuous but is an unstable fracture because the anterior longitudinal ligament is ruptured. PV Card: C1 and C2 Fractures and Injuries [+]
Trick of the trade: Single digital block
Your next ED chart: Finger injury The finger needs to be anesthetized. Patient: “I have had this freezing before. The needles really hurt! Is there anything else less painful? ” [+]
Director of Growth, Strategic Alliance [+]
Trick of the Trade: Toenail splinting for ingrown toenails
It is 4 a.m. You pick up a chart. Toe pain. Thinking this could be an easy injury, you walk over to the patient, only to discover: bilateral ingrown toenails. Your heart sinks. In your head, you are thinking: Lateral nail resection? Nail removal? This could take a while. Is there a less invasive method for treating an ingrown toenail? [+]
Paucis Verbis card: When murmurs need echo evaluation
Have you been in a situation where you are the first to detect a cardiac murmur in a patient? If you are hearing it in a busy, loud Emergency Department, I find that it's at least a grade III. Should you order an echocardiogram for further outpatient evaluation? It depends on the grade and characteristic of the murmur, in addition to the patient's symptoms. For instance, all diastolic murmurs require an echo. There is a useful ACC/AHA algorithm which helps you decide. PV Card: When Murmurs Need Echocardiography Evaluation Adapted from [1] Go to ALiEM (PV) Cards for more resources. Thanks [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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