Patwari Academy videos: Spider and Hymenoptera bites
These two videos continue on the theme of envenomations. Watch these great videos on the consequences and management of bites by spiders and Hymenoptera species (bees, wasps, ants). Hymenoptera bites can cause all sorts of complications, but one of the most worrisome includes anaphylaxis, which is also reviewed in the video. [+]
ALiEM Bookclub: The Checklist Manifesto
Introduction Checklists have now almost become status quo in current medicine. My earliest encounter with the surgical checklist phenomenon was during PGY1 as an off-service intern. At this point, early adopters were running around with “Checkmark” safety-pins on their surgical caps, trying to encourage everyone to take up the cause. There were jokes and exasperated sighs each time a case started, but most complied with the task at the behest of opinion leaders (often the senior OR nurses in the room). Two years later I returned to see a culture change. OR teams seemed to communicate better, things seemed to [+]
Pediatric febrile seizure: When do I need to do a lumbar puncture?
You are in the ED when a 7 month old is brought in by EMS after a witnessed generalized seizure. The grandmother reports that the child has had URI symptoms for a couple of days and then developed a fever today. Shortly after giving ibuprofen, the child began to seize with arms and legs twitching. The episode lasted approximately 8 minutes and when EMS arrived, the child was sleepy, but arousable. The glucose was 92 mg/dL en route. On exam in the ED, child is awake and staring at you to make the next move… Vitals: Temp 39C, P 136, [+]
Posterior Myocardial Infarction: How Accurate is the Flipped ECG Trick?
Posterior myocardial infarction (MI) represents 3.3 – 21% of all acute MIs and can be difficult to diagnose by the standard precordial leads. Typically, leads V7 – V9 are needed to diagnose this entity. Luckily, leads V1 – V3, directly face the posterior wall of the left ventricle and are the “mirror image” of the posterior wall of the left ventricle. [+]
Safe dosing of nebulized lidocaine
Serum lidocaine levels correlate well with observed clinical effects. As the concentration increases, lightheadedness, tremors, hallucinations, seizures, and cardiac arrest can occur. Levels > 5 mcg/mL are associated with serious toxicity. With so many concentrations (1%, 2%, 4%) and routes of administration available, the total dose of lidocaine is always a concern. [+]
Trick of the Trade: The PIPP for deep peripheral IVs in obese patients
The Case A 500-pound morbidly obese male presents to your ED complaining of mild shortness of breath and palpitations. A quick ECG shows SVT with a rate of 160 bpm. His BP is in the 130s systolic, and he is otherwise stable. You know you have a bit of time. Meanwhile, the nurses begin searching for veins to start an IV… [+]
Patwari Academy videos: Snake bites!
There are about 8,000 snakebites per year in the United States and 10% are fatal (see comments)! If this doesn’t scare you enough to view these videos, watch these videos to see Dr. Rahul’s Patwari’s amazing digital drawing skills. In addition to a brief 4-minute overview on snake bites, Rahul also goes more in depth about crotalids (rattlesnakes) and elapids (coral snakes) specifically. [+]
Tips on engaging Twitter newcomers
Twitter plays a central role in the continuing medical education for many current and future Emergency Medicine physicians. While there are hundreds of active self-identified EM physicians on Twitter (and perhaps thousands more non-self-identified EM doctors, doctors from other specialties, and students with an interest in the field), Twitter-using EM docs are still the exception, not the rule (Lulic I, Kovic I. Emerg Med J, 2013). Despite the many reasons that an EM doctor can benefit from being on Twitter (my slides from recent SUNY Downstate conference), convincing “would-be’s” to sign up for Twitter accounts frequently presents challenges. Here are [+]
A time-based approach to elderly patients with altered mental status
It’s 7 am on a Monday. Your first patient is an 82 year-old woman who was brought in by EMS from an assisted living facility. All EMS can tell you is that she was not acting herself. You enter her room and introduce yourself. “Hello Mrs. Jones. How are you today?” The woman startles, “Well, you see, I went to put my dog out, and then I was just walking, and couldn’t remember. So it’s all coming full circle, and then I ate a sandwich.” Just then EMS rolls in with another patient, a 75 year-old male coming from home, [+]
PV Card: Intimate partner violence
In the Emergency Department, we too often under-estimate our patients' likelihood for intimate partner violence (IPV). Unfortunately, there is no perfect screening test to detect this. So one must maintain a high index of suspicion. Once you detect it, what questions should you ask to ensure her/his safety and how do you optimize the resources available to her/him? Created by Trevor Wilson (UCSF medical student) and Dr. Beth Kaplan (UCSF/SFGH), the following PV pocket card reviews how to screen, document, intervene, and provide resources for the patient. Learn the "SAFE" questions.1,2 PV Card: Intimate Partner Violence Go to ALiEM [+]