Paucis Verbis card: Burn Wounds
Burn classification and management are key skills for ED providers to remember. Depending on the prevalence of burns in your ED, it may be hard for forget the details. So here is a PV reference card on the rule of 9's, different classifications of burns, and indications for burn unit referral. Update (April 22, 2016): This card was updated by Dr. Christian Rose (UCSF-SFGH) to reflect current evidence that topical antibiotics and honey are IN, while silver sulfadiazine is OUT for partial-thickness burns. PV Card: Burn Wounds Adapted from [1-3] Go to ALiEM (PV) Cards for more resources. References Gómez R, Cancio L. Management of burn wounds in the emergency department. Emerg [+]
Trick of The Trade: Peritonsillar Abscess Drainage 2.0
Back in September of 2009 Michelle shared valuable Tricks of The Trade regarding drainage of peritonsillar abscesses. Today we revisit the topic and add two more tricks to avoid hitting “big red” a.k.a. the internal carotid artery. [+]
Paucis Verbis card: Ascites assessment with paracentesis
A paracentesis procedure is often performed in the Emergency Department to rule a patient out for spontaneous bacterial peritonitis (SBP). Do you check coagulation studies before performing the procedure? How comfortable do you feel that the patient has SBP with an ascites WBC > 500 cells/microliter or ascites PMN > 250 cells/microliter? This installment of the Paucis Verbis (In a Few Words) e-card series provides an evidence-based review of the literature on topics related to the paracentesis procedure. Especially helpful is the pooled data of likelihood ratios. Like most everything in medicine, a lab test should be used in conjunction [+]
Trick of the Trade: Finding the subtle pneumothorax
Can you see the pneumothorax? Small pneumothoraces can be difficult to detect on chest xrays. Overlying ribs, other bony structures, and soft tissue can obscure subtle findings. For a patient at risk for a small pneumothorax, you can use your digital radiology PACS system to improve your ability to spot them. [+]
Paucis Verbis card: Appendicitis – ACEP Clinical Policy
Appendicitis is a common presentation in the Emergency Department. Dilemmas arise when deciding whether to image patients with equivocal symptoms and WBC lab results. Given the risk of ionizing radiation with CT scans, we should ideally minimize the number of CT scans ordered in these patients without mistakenly sending patients home with an early appendicitis. A perforated appendix places the patient at risk for bowel obstruction, infertility (in women), and sepsis. Where does the American College of Emergency Physicians (ACEP) stand on the critical issues surrounding the evaluation of appendicitis? This installment of the Paucis Verbis (In a Few Words) [+]
Trick of the Trade: Double staple gun
How do you approach the repair of scalp lacerations in a child? What factors are you considering? Is the wound suspicious for child abuse? Procedural sedation versus local anesthesia of the wound Staples versus hair apposition technique (HAT trick) for wound closure This trick of the trade pearl addresses the stapling technique for scalp laceration repair. Perhaps the child’s hair is too short for the HAT trick. [+]
Paucis Verbis card: Septic Arthritis
In the workup of monoarticular arthritis, the question that emergency physicians constantly struggle over is whether the patient has a nongonococcal septic arthritis. This joint infection alarmingly damages and erodes cartilage within only a few days. This installment of the Paucis Verbis (In a Few Words) e-card series reviews the JAMA Rational Clinical Examination article which asks "Does this patient have septic arthritis?" Pooled sensitivities and likelihood ratios were calculated. These statistics are always helpful when trying to figure out the patients probability of having a septic joint. I was surprised to learn that only about 50% of patients with [+]
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.
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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