• MDI

Paucis Verbis: Asthma classification

By |Categories: ALiEM Cards, Pulmonary|

Emergency physicians have the opportunity to educate patients and prescribe chronic inhaled corticosteroids to patients who should be on these medications chronically. Patients may be more receptive to education and advice given immediately after an asthma exacerbation, managed in the ED.  Using the National Institute of Health/ National Asthma Education and Prevention Program classification system, physicians can quickly determine if the patient is a candidate for inhaled corticosteroids and initiate therapy accordingly. […]

  • Nebulized OJ

Trick of the trade: Nebulized … orange juice?

By |Categories: Tricks of the Trade|

In my theme of detoxifying malodorous smells in the ED, I recently learned of a new way of masking odors. Imagine the stress on your olfactory nerves from the combined effects of urinary and fecal incontinence from a nursing home patient. An ingenious nurse proposed nebulizing actual coffee within the room. Unfortunately, our ED was out of coffee at the moment. […]

  • Periapical Abscess

Paucis Verbis: Dental infections

By |Categories: ALiEM Cards, Dental|

To follow up with the wildly popular Paucis Verbis card made by Dr. Hans Rosenberg (University of Ottawa), here is his card on Dental Infections. This card summarizes common dental infection complaints (like the periapical abscess seen to the right) that we see in the Emergency Department. […]

  • Saline Syringe

Trick of the Trade: Corneal reflex test

By |Categories: Neurology, Tricks of the Trade|

The corneal reflex test (blink test) examines the reflex pathway involving cranial nerves V and VII. Classically the provider lightly touches a wisp of cotton on the patient’s cornea. This foreign body sensation should cause the patient to reflexively blink. This maneuver always makes me a little worried about causing a corneal abrasion, especially if you are examining a very somnolent patient. You are wondering — Is there no blinking because you’re not touching the cornea hard enough? You apply harder pressure but still no blink. You repeat the test and now the patient finally blinks. That’s 3 times you’ve [...]

  • Dental trauma teeth mouth

Paucis Verbis: Dental trauma

By |Categories: ALiEM Cards, Dental|

How cool is this — I have talented emergency physicians contributing Paucis Verbis card content! This week features excellent pearls on Dental Trauma by Dr. Hans Rosenberg (University of Ottawa). Here’s his recent article in Annals of EM on reimplantation of avulsed teeth.1 […]

  • CXR oblique

Trick of the Trade: Oblique CXR to look for pneumothorax

By |Categories: Radiology, Tricks of the Trade|

 Supine chest xrays have an extremely low sensitivity (12-24%) in detecting pneumothoraces. Because a pneumothorax layers anteriorly on an AP CXR film, the xray beam is perpendicular rather than tangential to the pneumothorax edge. This makes visualizing a small to moderate sized pneumothorax extremely difficult. So you are left to look for indirect signs such as a deep sulcus at the costophrenic angle or subcutaneous air. I’m often surprised at how large of a pneumothorax can be missed on CXR based on CT imaging. The image to the right shows a large left-sided pneumothorax on CT. What if you [...]

  • EKG anatomy

Paucis Verbis: AMI and ECG Geography

By |Categories: ALiEM Cards, Cardiovascular, ECG|

Sometimes a picture is worth MORE than a 1000 words. Such is the case of the above illustration that I saw on the Life In The Fast Lane blog. When I first saw it, I knew that I immediately had to find out who made the graphic. It turns out it is the multitalented Dr. Tor Ercleve, who is an emergency physician at Sir Charles Gairdner Hospital and an established medical illustrator. This graphic demonstrates the EKG findings for the various types of acute MI's as broken down by coronary vascular anatomy (right coronary artery, left circumflex artery, left anterior descending [...]

  • Pupil Constriction Demo

Trick of the Trade: Check pupillary constriction with ultrasound

By |Categories: Ophthalmology, Tricks of the Trade, Ultrasound|

In some trauma patients with head and face trauma, you will need to check their pupillary response to light. Severe periorbital and eyelid swelling, however, make this difficult. You want to minimize multiple attempts to retract the eyelids because of the risk of a ruptured globe. What’s a minimally painful and traumatic way to check for pupillary constriction? […]

  • HIV exposure

Paucis Verbis: Post-exposure prophylaxis (non-occupational)

By |Categories: ALiEM Cards, Infectious Disease|

You know how chief complaints present to the ED in multiples? In one week, I had several cases where patients were asking for post-exposure prophylaxis treatment NOT in the content of a sexual assault. I haven’t had to manage such cases in a long time and so needed to look up the recent guidelines from the CDC.1 […]

  • SteriSuture

Trick of the Trade: Steristrip-suture combo for thin skin lacerations

By |Categories: Geriatrics, Trauma, Tricks of the Trade|Tags: |

Lacerations of elderly patients or chronic corticosteroid users can be a challenge because they often have very thin skin. Sutures can tear through the fragile skin. Tissue adhesives may not adequately close the typically irregularly-edged laceration. How do you repair these lacerations? Do you just slap a band-aid on it? […]