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Bio at MichelleLinMD.com

Look at the BUN:creatinine ratio. If >20, consider hypovolemia. If >30, consider upper GI bleed. Based on JAMA 2012 systematic review. Likelihood ratio LR of 7.5 for UGIB! Great shift and pearls with Dr @Jonathan.kobles, Dr @teemoetae , Dr @jay.roever
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#postitpearls #emergencymedicine #gastroenterology #foamed #physicianassistant #nursepractitioner
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🚨 Hot off the press: A single episode of moderate to severe diabetic ketoacidosis (DKA) in children results in lower IQ, item-color recall, and forward digit span tests.
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Abstract: https://care.diabetesjournals.org/content/early/2020/09/10/dc20-0187
(Link in bio)
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#postitpearls #pecarn #emergencymedicine #endocrine #pediatrics #nursepractitioner #physicianassistant #foamed
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Right lower quadrant (RLQ) abdominal pain - is it a kidney stone or appendicitis? Quick doorway diagnosis with Dr. @rene.am -
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If constantly repositioning and shifting because unable to get comfortable ➡️ kidney stone
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If prefers to lie still in gurney because movement makes the pain a ton worse (peritoneal) ➡️ appendicitis
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Of course, not a perfect algorithm but an interesting tip to help differentiate
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#postitpearls #emergencymedicine #abdominalpain #nursepractitioner #physicianassistant #foamed
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Domestic violence on the rise globally during the COVID-19 pandemic. Be more vigilant in screening in the Emergency Department. Great shift with Drs. @rene.am, @teemoetae, and @instasojagram.
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Link in bio: https://www.theguardian.com/society/2020/mar/28/lockdowns-world-rise-domestic-violence
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#postitpearls #emergencymedicine #domesticviolence #covid19 #trauma #nursepractitioner #emergencydepartment #physicianassistant #foamed
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Hangman Fracture: C2 fracture which typically occurs in elderly falls and motor vehicle crashes. Mechanism: Hyperextension injury pattern. Tip: Search for concurrent other cervical spine injuries. Great shift with Dr. @instasojagram Yi.
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#postitpearls #foamed #emergencymedicine #trauma #neurosurgery #nursepractitioner #physicianassistant
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For patients with anxiety, consider teaching them 📦 BOX BREATHING.
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1. Deeply inhale by nose for 4 sec slowly
2. Hold breath for 4 sec
3. Exhale fully by mouth for 4 sec
4. Hold breath for 4 sec
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Do this for 4 cycles. H/t to Dr @vero_.man !
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#postitpearls #emergencymedicine #meditation #anxiety #nursepractitioner #physicianassistant
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Myth buster: No lidocaine needed in a GI cocktail for dyspepsia/peptic ulcer disease. Antacid monotherapy is the same for pain relief at 30 minutes... plus higher patient satisfaction. Check out great review at First 10 EM site (link in bio): https://www.google.com/amp/s/first10em.com/dont-use-lidocaine-for-epigastric-pain/amp/
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👋 bye lidocaine. Shout out to Dr. @twinniful .
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#postitpearls #emergencymedicine #foamed #gastroenterology #lidocaine #gi #physicianassistant #nursepractitioner
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BEN-NO
Just say NO to BENZO
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The 2018 American Geriatric Society recommends avoiding benzodiazepines in elderly patients. They increase the risk of falls and delirium. It made the Beers Criteria list - https://qioprogram.org/sites/default/files/2019BeersCriteria_JAGS.pdf (link in bio) h/t Dr. @vincey.ig!
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#postitpearls #emergencymedicine #foamed #geriatrics #pharmacology
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Parotid salivary stone (sialolithiasis) management - don’t forget sialogogues like sour candy or lemon drops. @twinniful
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#postitpearls #emergencymedicine #foamed #nursepractitiioner #physicianassistant #ent
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Open fractures based on Gustilo classification:
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Give 2g and not the standard 1g for adults. Also note that you need to add an aminoglycoside if Type III to cover for polymicrobial contamination (esp gram negatives). Type III has subtypes A, B, C with good local wound coverage, flap needed, and vascular damage, respectively.
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🙏 to Superstar Senior Resident Dr. @sraouf on his Pre-Attending shift showing how it’s done. Also allowed me to do a little bedside teaching on a busy shift!
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#postitpearls #emergencymedicine #orthopedics #nursepractitioner #physicianassistant #infectiousdisease
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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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