Simulation Trick of the Trade: Blindfold the Leader
Simulations are routine now in medical training. But sometimes routine can start to get boring! All learners now know, especially for high fidelity simulations, to prepare for the unexpected. The stable patient will inevitably crash, maybe when your back is turned; the confederate in the room may or may not be a friend or a foe, you may never know! But these twists have become so integral to the simulation case that most learners know how to deal with it, or at the least know to anticipate it. But here is an idea for adding a new challenge to a stale simulation case. Blindfold the leader! [+]
Open Educational Resources
The Internet has not only facilitated connectivity between people, but it has also helped us to connect with educational material quite different from that of a physical textbook. We are consuming information at a much more rapid rate, and we are also becoming producers of content online. With the use of hyperlinks we are also connecting one content material with another, allowing for a more dynamic-instantaneous flow of knowledge as opposed to the static print in a physical textbook. People have started seeing the potential that this brings to education and are placing educational content online. These educational materials include [+]
MEdIC series: The Case of the Difficult Consult
Inspired by the Harvard Business Review Cases and led by Dr. Teresa Chan (@TChanMD) and Dr. Brent Thoma (@BoringEM), the Medical Education In Cases (MEdIC) series puts difficult medical education cases under a microscope. On the fourth Friday of the month we will pose a challenging hypothetical dilemma, moderate a discussion on potential approaches, and recruit medical education experts to provide “Gold Standard” responses. Cases and responses will be made available for download in pdf format – feel free to use them! If you’re a medical educator with a pedagogical problem, we want to get you a MEdiC. Send us your most difficult dilemmas and help the rest of us to [+]
Bundle Branch Blocks (BBBs) 101
Recently, I have been asked by several students at my home institution (UTHSC at San Antonio) to help them understand bundle branch blocks. This is different than some of my usual posts because it is meant to be more educational than evidence based. So here we go. The normal conduction system of the healthy heart is shown to the right. If there is a delay or block in the left or right bundle, depolarization will take longer to occur. Therefore we get a widened QRS (>0.12 sec or >3 small boxes). [+]
R-Wave Peak Time (RWPT) in Lead II: One Simple Step to Differentiate Wide Complex Tachycardias
There are several algorithms that are currently used to help distinguish Supraventricular Tachycardia (SVT) with aberrancy and Ventricular Tachycardia (VT). Many of these algorithms lack specificity, and let’s face it, who can remember if the absence of an RS complex in the precordial leads is VT or SVT with aberrancy. So what if there was a criterion that had a good sensitivity (SN), specificity (SP), and was one simple step? [+]
PV Card: Brugada Criteria for SVT with Aberrancy vs Ventricular Tachycardia
Due to the overwhelming popularity of Dr. Salim Rezaie's recent post discussing the Brugada criteria for SVT with aberrancy vs VT, Dr. Jason West (@JWestEM, an EM resident from Jacobi/Montefiore) kindly helped to co-author and package this information into a PV card for quick reference. To use this sequential, four-question approach, if at any time you answer YES to the question, it is ventricular tachycardia. PV Card: SVT vs VT - Brugada Criteria Adapted from [1] Go to ALiEM (PV) Cards for more resources. Reference Brugada P, Brugada J, Mont L, Smeets J, Andries E. A new approach to the differential diagnosis [+]
QI Series: Cellulitis vs Necrotizing Fasciitis
Case A 50-year-old male was referred to the ED for evaluation of cellulitis. The patient had developed pain and swelling in his right groin region 5 days earlier. He had seen his physician 3 days before the ED visit and was started on Doxycycline. On the day of evaluation, he had returned to the office with increasing redness so was referred to the ED. [+]
New Quality Improvement Series: Be a detective to avoid errors
When you attend Morbidity & Mortality or Quality Improvement (QI) Conferences, the cases presented often have teaching points, which revolve around potentially avoidable errors. Subtle and not-too-subtle clues often reveal themselves along the way, which could have been detected sooner. This ALiEM QI Series, hosted by Dr. Steven Polevoi (UCSF EM Medical and QI Director), was created to help you become a better detective in finding these clues early in the patient’s course. “Learn from the mistakes of others. You can’t live long enough to make them all yourself.” – Eleanor Roosevelt [+]
Patwari Academy videos: EBM Treatment Studies (part 2)
Dr. Rahul Patwari continues with the fourth and fifth videos in this series on Evidence Based Medicine (EBM) and Treatment Studies (see first three videos). These two videos are about the concept of Confidence Intervals and Patient Applicability. The second video below makes great points about whether a published study is applicable to YOUR patient. Don’t fall into common traps. [+]
The Checklist Manifesto: ALiEM Book Club Synopsis
Our dear readers have chimed in and we’ve received amazing commentary and feedback regarding this month’s book The Checklist Manifesto. Please read the summary of the discussion below. CHECKLISTS ARE EVERYWHERE IN EMERGENCY MEDICINE Our readers have spotted checklists in a number of places including PALS/ACLS algorithms, Procedural Sedation protocols, and Clinical Decision Rules. Dr. Javier Benitez (@jvrbntz) stated that he uses a checklist for resuscitations at the start of shifts. Dr. Michelle Lin (@M_Lin) stated “We already use our own mental checklists in Med[icine]. It’s just not explicitly shared. Should have more overt shared checklists.” [+]