• Swine Flu

Paucis Verbis: Influenza – To treat or not to treat?

By |Categories: ALiEM Cards, Infectious Disease|

It’s coming. Influenza season is almost upon us. Influenza season typically peaks in the United States during the Jan-Feb months and can start as early as October. You can read about the 2011-12 seasonal flu data on the CDC website. Should you give a patient with influenza an antiviral agent or just provide supportive therapy? […]

  • Head Elevated Trumpet

Trick of the Trade: Nasal cannula oxygenation during endotracheal intubation

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

You are managing a 300-pound patient with a long history of severe COPD, who now requires intubation because of a pneumonia and COPD exacerbation. You anticipate that the patient may be a difficult airway intubation and may desaturate quickly during laryngoscopy. While you are setting up to orotracheally intubate this patient, you preoxygenate this patient as best as you can with a non-rebreather mask. What can you do to prolong the patient’s time-to-desaturation so that you aren’t as rushed to place the endotracheal tube? […]

  • Ventilator

Paucis Verbis: Ventilator settings for obstructive lung disease

By |Categories: ALiEM Cards, Pulmonary|

Following up with last week's Paucis Verbis card on Ventilator Settings for Acute Lung Injury and ARDS, here is the card on Ventilator Settings for Obstructive Lung Disease. This is for patients who present with acute asthma or COPD exacerbation who require endotracheal intubation. What initial ventilator settings should you set for these patients?   Go to the ALiEM Cards site for more resources. Thanks to Dr. Jenny Wilson for the card and Dr. Scott Weingart for the original stellar podcast from which this card was derived.

  • Fentanyl

Trick of the Trade: Opioids for air hunger

By |Categories: Tricks of the Trade|

A patient presents with significant shortness of breath from a COPD exacerbation. His room air saturation is 80%, respiratory rate of 30, and is uncomfortably seated in a tripod position. You administer the usual regimen: Oxygen by face mask Nebulized albuterol and atrovent Solumedrol Bipap Set up for possible intubation With the Bipap mask on, the patient’s subjective sense of dyspnea and “air hunger” seems to make it harder for him to tolerate the tight-fitting mask.   […]

  • Needlestick hotline

Trick of the Trade: Needlestick hotline 888-448-4911

By |Categories: Infectious Disease, Tricks of the Trade|

You are a fourth-year medical student and super-excited to be doing your first supervised central line procedure on an actual patient. You have done so many central lines on mannequins and simulations. You feel ready. In your excitement, however, you stick yourself with the 22 gauge finder needle after you successfully get a flash-back of the patient’s venous blood. After handing off the procedure to your senior resident, you go into a mild panic. Your patient is a known HIV patient with an unknown CD4 count and viral load. After taking off your gloves and washing your hands, you report [...]

  • Fagan Nomogram Example

Paucis Verbis: Does this DM leg ulcer have osteomyelitis?

By |Categories: ALiEM Cards, Infectious Disease, Orthopedic|

We sometimes see diabetic patients in the ED for a worsening foot ulcer. Sometimes it’s the chief complaint. Other times, however, you just notice it on physical exam. So, be sure you examine the feet of your diabetic patients. Occasionally, you’ll be surprised by what you find. Several questions come up with diabetic foot ulcers: Is it a true diabetic foot ulcer, or is it an arterial or venous insufficiency ulcer? Is there underlying osteomyelitis? How can I best diagnostically work this foot ulcer up for osteomyelitis? What is the Wagner grade of this ulcer? (I think it’d be Grade [...]

  • Child ears covered

Trick of the Trade: Pediatric ear exam

By |Categories: ENT, Pediatrics, Tricks of the Trade|

Performing a physical exam on frightened pediatric patients can often be challenging. I am always thrilled to add more child-whisperer techniques to my arsenal of tricks. I have written in the past about: Balloonimals iPhone app to grossly assess peak flow Candleflame iPhone app to grossly assess peak flow Eye Handbook iPhone app with pediatric fixation animation targets Casting/splinting your buddy bear What’s your trick on performing an otoscope exam of the ears? […]