• Guidewire

Trick of the Trade: A removable guidewire

By |Categories: Tricks of the Trade|Tags: |

An essential skill of any innovative troubleshooter in the Emergency Department is the ability to recognize when one piece of equipment may be used elsewhere. For instance, what’s your go-to approach when looking for a spare guidewire? Let’s say you are trying to salvage an ultrasound-guided basilic vein IV catheterization. Here’s where I go for guidewires: Central line kits Pneumothorax pigtail kits Seldinger-based cricothyrotomy kits […]

Paucis Verbis: Serotonin syndrome

By |Categories: ALiEM Cards, Tox & Medications|

What exactly IS serotonin syndrome? It's caused by the excess of serotonin and presents classically as: Altered mental status Autonomic instability Neuromuscular hyperactivity Fortunately, there's a nice algorithm (Hunter's decision rule) which helps you decide whether it is serotonin syndrome or not. I also include a table, which I adapted from the New England Journal of Medicine review article on Serotonin Syndrome, which helps you to differentiate it from its mimickers, such as anticholinergic syndrome, neuroleptic malignant syndrome, and malignant hyperthermia. PV Card: Serotonin Syndrome   Adapted from 1,2 Go to the ALiEM Cards site for more resources. A video to remind you [...]

  • Captain Morgan Technique

Trick of the Trade: Captain Morgan technique for hip dislocation

By |Categories: Orthopedic, Tricks of the Trade|Tags: |

https://www.youtube.com/watch?v=WXN9RMjyn4M Relocation of a hip joint is often quite a sight to see in the ED. A commonly taught technique is the Allis maneuver (watch the first 45 seconds of the above video from the Medical College of Georgia). It has always seemed a bit precarious to me having someone stand on the patient’s bed. […]

Paucis Verbis: Feedback card

By |Categories: ALiEM Cards, Medical Education|

Today’s Paucis Verbis card is a little different. This card focuses on helping you give talking points when giving feedback to a learner on shift. This could be a medical student or resident. Dr. David Thompson (UCSF-San Francisco General Hospital) sent this great card to me and I thought it was too useful NOT to share. It’s handy on shift, which ultimately is the purpose of these Paucis Verbis cards. These are useful especially for senior residents, who are supervising medical students and junior residents. […]

  • Scalp laceration bandage

Trick of the Trade: Bandaging the scalp laceration

By |Categories: Tricks of the Trade|Tags: |

Scalp lacerations are one of the most common injuries which present to the Emergency Department. Applying a dry bandage over the staples or sutures can be a challenge because the tape just has nothing to adhere to. We reviewed the use of tubular cotton gauze to create a beanie hat, but what should you do if you can’t find any tubular gauze? Ever since I wrote about the beanie hat trick, people in the ED have been using the tubular gauze more and we’re always out of stock whenever I look for it! […]

  • Dizziness

Paucis Verbis: Acute vestibular syndrome and HINTS exam

By |Categories: ALiEM Cards, Neurology|

What is your diagnostic approach to the acutely vertiginous patient? The bottom-line question is: Is the cause peripheral or central in etiology? In this great 2011 systematic review article in CMAJ on Acute Vestibular Syndrome (AVS), the authors review how (un)predictive elements of the history and physical exam are. By definition of AVS, symptoms must be continuous for at least 24 hours and have no focal neurologic deficits. […]

  • Tape IV Sweaty Skin

Trick of the Trade: Securing a peripheral IV on sweaty skin

By |Categories: Tricks of the Trade|

Patients can become extremely diaphoretic with high fevers or if under the influence of PCP or a stimulant. Slippery, sweaty skin can pose a problem when securing peripheral IV’s. Adhesive tapes that are typically designed for securing these IV’s often slip off… immediately followed by the IV falling out. How can you secure the IV … without using staples and sutures?  […]

  • EKG vectors

Paucis Verbis: Lead aVR on EKG

By |Categories: ALiEM Cards, Cardiovascular, ECG|

What lead is the most overlooked on the EKG?  Answer: aVR Lead aVR can provide some unique insight into 5 different conditions: Acute MI Pericarditis Tricyclic antidepressant (TCA) and TCA-like overdose AVRT in narrow complex tachycardias Differentiating VT from SVT with aberrancy in wide complex tachycardias by using the Vereckei criteria (possibly better than Brugada criteria) […]