• Cerebrovascular Anatomy

Paucis Verbis: Blunt cerebrovascular injuries

By |Categories: ALiEM Cards, Cardiovascular, Radiology, Trauma|

In the setting of blunt trauma, it is easily to overlook a patient’s risk for blunt cerebrovascular injuries (BCVI). These are injuries to the carotid and vertebral arteries. Often they are asymptomatic with the initial injury, but the goal is to detect them before they develop a delayed stroke. Who are at risk for these injuries? What kind of imaging should I order to rule these injuries out? Do I really treat these patients with antithrombotic agents even in the setting of trauma to reduce the incidence of CVA? […]

  • Mini suction

Trick of the Trade: A mini-suction device

By |Categories: Tricks of the Trade|

You are doing a shift in the pediatric ED and you are evaluating a kid with a small bead in her ear. There are a ton different approaches you can use (eg. tissue adhesive glue on a q-tip stick). If the bead is in too deep, blindly trying to adhere the foreign body to the glue is a bit risky. Sometimes applying gentle irrigation might not be enough to wash out the bead. You want to avoid irrigation if you worry about a tympanic membrane rupture. […]

  • Diarrheal monster

Paucis Verbis: Clostridium Difficile

By |Categories: ALiEM Cards, Gastrointestinal|

I just finished taking the 2011 LLSA exam to remain eligible for recertification. The only good thing about this test is that it gives me interesting topics for my Paucis Verbis cards. Here’s a card on a disease process that is becoming increasingly prevalent — Clostridium difficile. This is a summary based on the 2010 guidelines by Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). […]

  • Shoulder dislocation xray

Trick of the Trade: Cunningham maneuver for shoulder dislocation

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

We commonly see patients with shoulder dislocations in the Emergency Department. There are a myriad of approaches in relocating the joint, which includes scapular rotation, Snowbird, and Kocher maneuvers. I recently stumbled upon the Cunningham technique after hearing about it from Dr. Graham Walker (of MDCalc fame) on TheCentralLine.org. […]

  • Lidocaine Bottle

Trick of the Trade: I need more lidocaine but I have sterile gloves on!

By |Categories: Tricks of the Trade|

How often has this happened to you — You are in the middle of a sterile procedure (chest tube, suturing, central venous line, lumbar puncture) and you realize that you need more lidocaine to provide better topical anesthesia. You don’t have any more in your kit and you are alone in the room with the patient. “Uh, can someone help me out there?” […]

  • Urine Cup Finger

Trick of the Trade: Fingertip injuries

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

Fingertips can get injured in a variety of ways such as machetes, meat grinders, and broken glass. You name it, and we’ve probably seen it. Some don’t actually need anything invasive done because the skin is basically just torn off. The wound just needs to be irrigated, explored, and then bandaged to allow for secondary wound closure. What do you do if the finger injury keeps oozing and the finger tip is too painful for the patient to apply firm pressure? Poking the finger with 2 needles to perform a digital block seems a bit overkill. […]

Paucis Verbis: Pulmonary Embolism Clinical Prediction Rules

By |Categories: ALiEM Cards, Pulmonary|

“Should I get a D-Dimer test or CT chest angiogram on my patient with atypical chest pain to rule-out a pulmonary embolism?” This is a common question asked by emergency physicians on a routine basis. Here are 3 clinical prediction rules: PERC, Wells, and Simplified Geneva Score. Personally, I’ve never used the Geneva Score, but it’s worth looking at. […]

  • Tea bag

Tricks of the Trade: Tea bags to the rescue

By |Categories: Tricks of the Trade|

  I have heard of using tea bags under your eyes to reduce puffiness, but to combat odors in the ED? In my growing list of “Tricks of the Trade” tips for protecting your olfactory nerves (Antacid booties for toxic sock syndrome, aerosolized orange juice, abscess drainage using suction), I got a clinical gem from Dr. James Juarez (Rogue Valley Medical Center in Ashland, OR) after my recent Tricks of the Trade talk at High Risk EM in San Francisco. […]