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 [+]
Trick of the Trade: Retracting Swollen Eyelids
Eyelids can become edematous from blunt trauma and local inflammation, making it difficult to visualize the orbit. How do you retract the eyelids, if you don't have the fancy ophthalmology eyelid retractors? Trick of the Trade Use a Q-tip I thought of this idea when I was rolling up a projector screen in a conference room. Why can't we use this rotational concept on the upper eyelid to retract it? Rest the Q-tip on the surface of the upper eyelid and slowly rotate the Q-tip to "roll" the eyelid out of the way. Below are a series of photos of [+]
Trick of the trade: Eye irrigation setup
Morgan lens are placed to irrigate eyes splashed with foreign substances. Whenever I place them, images of horror and torture movies arise. Especially for patients who aren't used to having something touch their eyes like contact lens, the Morgan lens gives them the heeby-jeebies. For the past several years, I've stopped using Morgan lens and have started using something that all Emergency Departments have -- nasal cannulas for oxygen administration. They are perfect for high-volume eye irrigation. Instead of attaching the nasal cannula to an oxygen port, attach it to the end of IV tubing, which in turn is attached [+]
Paucis Verbis card: ABG interpretation
I have yet to find a better arterial blood gas interpretation review article than the 1991 Western Journal of Medicine summary by Dr. Rick Haber. This installment of the Paucis Verbis (In a Few Words) e-card series reviews ABG Interpretation. The recent addition of an ABG machine in our ED has made a tremendous difference in our ability to care for undifferentiated patients. This is a refresher in making heads and tails of mixed acid-base disorders. Adapted from [1] Go to ALiEM (PV) Cards for more resources. Reference Haber R. A practical approach to acid-base disorders. West J Med. 1991;155(2):146-151. [PubMed]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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