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Bio at MichelleLinMD.com

Corner sutures: Avoid flap ischemia with this elegant half-buried horizontal suture technique.
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PRO TIP:
1. Draw an imaginary horizontal line through where the flap tip will be approximated.
2. Start and end your suture inferior to this horizontal line or else the knot will overlap the tissue flap. Plus it won’t pull tension enough on the flap to bring it into the gape.
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Amazing 🧶 suturing ninja skills by Dr. @micki_gt !
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#postitpearls #emergencymedicine #foamed #sutures #trauma #physicianassistant #nursepractitioner
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Cauda equina syndrome: Variable neurologic findings unilateral and bilateral but the most consistent early finding is urinary retention. Patient may be asymptomatic until urinary overflow incontinence. Check post-void residual! If >100-200 cc volume on ultrasound, there is retention. Great #postitpearls tip with @melyo7 @gonzalezsummers
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#emergencymedicine #foamed #neurosurgery #orthopedics #physicianassistant #nursepractitioner
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Pro tip for finding subtle head CT bleeds in the setting of trauma: Look just under the extra-axial hematoma along the inner table for COUP injury. Also look at the CONTRACOUP area. Think of the bouncing ball effect. Great shift with Dr. @micki_gt
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#postitpearls #emergencymedicine #foamed #nursepractitioner #physicianassistant #radiology #trauma
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Gallbladder Ultrasound: Can sometimes be tricky to obtain an adequate view because of body habitus, ribs, or bowel gas.
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TIP: Position the patient in left lateral decubitus to use the liver as an acoustic window. The gallbladder pops out - 🎉 - like magic sometimes. Clear scan with Dr. @kirstend23. Other biliary bedside ultrasound tips at http://aliemcards.com/cards/gallbladder-ultrasound/ (link in bio)
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#postitpearls #emergencymedicine #foamed #pocus #ultrasound #radiology #nursepractitioner #physicianassistant
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🚩 Foot Injury: Lisfranc fracture-dislocation
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The Lisfranc joint connects the metatarsals to the tarsals. The strong Lisfranc ligament tethers the second metatarsal to the first cuneiform. Fractures or disruptions involving the base of the first/second MT or distal first/second cuneiform likely disrupts the ligament, thus resulting in a Lisfranc injury. Treatment: Often ORIF required. https://www.orthobullets.com/foot-and-ankle/7030/lisfranc-injury (link in bio). Fascinating case with Dr. @kirstend23
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#Postitpearls #emergencymedicine #foamed #orthopedics #nursepractitioner #physicianassistant
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Tricyclic antidepressant (TCA) toxicity - watch out for arrhythmias and neurological complications. Sodium channel blocker and anticholinergic properties. When to give sodium bicarbonate boluses?
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Get an ECG EARLY. Unrecognized high risk features may lead to unstable ventricular arrhythmias.
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Cc: Dr. @jonathan.kobles , Dr “it’s my last residency shift” @olgayashira , and Dr “it’s almost my last residency shift but who’s counting!” @tlcheng ❤️ #foamed #postitpearls #toxicology #emergencymedicine #physicianassistant #nursepractitioner
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Acute necrotizing ulcerative gingivitis (ANUG) = trench mouth | Treatment: Oral hygiene mouth wash and oral antibiotic. Great discussion with @jonathan.kobles
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Bonus reminder: hey residents - don’t forget to schedule a dental appointment that you’ve been putting off!
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#postitpearls #emergencymedicine #foamed #dental #physicianassistant #nursepractitioner
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Gallstone ileus - An uncommon cause of bowel obstruction | It’s a large gallstone that travels from the gallbladder to wedge in the bowel via a biliary-enteric fistula. Treatment: enterolithotomy (exploratory laparotomy to make an incision and remove the stone)
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#postitpearls #foamed #emergencymedicine #surgery #gastroenterology #nursepractitioner #physicianassistant
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Anterolateral thigh numbness, tingling, or burning pain? Consider Meralgia Paresthetica. It’s the lateral femoral cutaneous nerve being compressed. This nerve runs shallow and just under the inguinal ligament, supplying sensation to the anterolateral thigh.
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Causes:
- Tight pants
- Obesity
- Pregnancy
- Local trauma
- Diabetes mellitus

@shoobyscoops #postitpearls #emergencymedicine #foamed #neurology #nursepractitioner #physicianassistant
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There is no magic 🎩 to an ED discharge glucose of 350 mg/dL for NON-insulin dependent diabetics. How often do you keep checking glucose levels for these patients for a few extra hours to hit this arbitrary cutoff? Two studies suggest this may not be necessary with 7-day followup outcomes.
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One study here https://pubmed.ncbi.nlm.nih.gov/27353284/ (link in bio)
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👏 Drs. @mindyinplace and Mauricio
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#emergencymedicine #endocrinology #foamed #nursepractitioner #physicianassistant
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Do you check and INR before your paracentesis procedures to drain ascites? Evidence suggests you do not need to, especially in the era of ultrasound to find the pocket of shallow fluid and to avoid the inferior epigastric artery. #postitpearls
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One Liver Unit looked at their 4700 paracentesis procedures and found 0.2% had severe hemorrhage post-paracentesis. INR and platelet counts were not association factors in these cases; however, renal dysfunction was. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2036.2005.02387.x (link in bio)
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👍🏽 💉 Dr. @kevrollz
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#emergencymedicine #foamed #gastroenterology #nursepractitioner #physicianassistant #foamed
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Management of alcohol withdrawal: There are pros and cons to each medication but here are half-life pharmacokinetic data for IV lorazepam (Ativan), IV diazepam (Valium), and IV phenobarbital. @alycap12
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#postitpearls #foamed #emergencymedicine #toxicology #pharmacology #alcoholwithdrawal
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Orthopedic #postitpearls tip: Beware of associated injuries with SCAPULA fractures. They require a high force to break. The National Trauma Registry Database publication in Trauma and Acute Care Surgery Journal 2008 (PMID 18695481) reports associated findings. Isolated scapula fractures, however, often are non-operatively managed.
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#foamed #emergencymedicine #orthopedics #trauma #nursepractitioner #physicianassistant
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Not everything is #covid19 - let’s not forget everything else we’ve learned in Emergency Medicine. A #postitpearl orthopedic refresher:
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🦴 Shoulder dislocations associated with 2 fracture patterns: Bankart and Hill Sachs
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#emergencymedicine #orthopedics #foamed #nursepractitioner #physicianassistant #radiology
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