The SCRAP Rule: Indications for chest CT in blunt trauma
At my institution, trauma patients frequently receive the “Pan Scan,” to rule out acute injury. Recently, Payrastre et al published the SCRAP Rule article in CJEM 2012 1 looking to derive and internally validate a clinical decision rule that would identify blunt trauma patients at very low risk for major thoracic injury with 100% sensitivity, thereby eliminating need for a chest CT. Currently, the decision on whether to perform a chest CT is made mostly by clinical judgment. [+]
Trick of the Trade: Making the NG and NP procedures less painful
When doing nasogastric (NG) tubes and fiberoptic nasopharyngoscopy (NP) procedures, there many approaches in how patients can be locally anesthetized. Getting things pushed up your nose is so profoundly irritating that most patients only give you 1 or 2 changes to get it right. One option is to use nebulized lidocaine, although it takes a while to prepare and anecdotally tends to numb mainly the hypopharynx, placing the patient at risk for aspiration later on. Another option is to use viscous lidocaine to coat the NG or NP tubing, but this is fairly messy and only mildly helpful. Commercial intranasal [+]
Learning Information Management instead of Evidence Based Medicine?
Keeping up with the literature these days is quite a daunting task. Medical information has increased exponentially over the past few decades and continues to do so. We spend a great deal of time and energy memorizing information which soon may become obsolete (see excerpt from the book The Half-Life of Facts by Arbesman). Expecting physicians to keep a busy practice AND keep up with all the most current literature is impractical. By the time textbooks are published, the information is already a few years old and this puts us at risk of not practicing the most up to date [+]
Patwari Academy video: Altered mental status
Get an organized approach on the broad chief complaint of “Altered Mental Status”. Learn about the AEIOU TIPS mnemonic om this 20 minute video by Dr. Rahul Patwari. [+]
Director of Growth, Strategic Alliance Initiative, Center [+]
Poll: Disability Insurance – Yes or No?
I am set to graduate residency this June 2013 and among all the other things on my to-do list such as credentialing paperwork for my future employer is to explore disability insurance. Because I know very little about insurance, I decided to do some research. What is disability insurance? Why should I get it? Do I need it as a physician? Do I need it as an emergency physician? Take a poll and see the crowd-sourced results… [+]
Management of Syncope
“Done Fell Out”, or DFO, is a common saying in the South to describe syncope. Although the saying is funny the diagnosis is not. Syncope accounts for about 3–5% of ED visits and 1–6% of hospital admissions. In patients >65, syncope is the 6th most common cause of hospitalization. How do you approach the management of patients with syncope? [+]
Sim Case Series: Perimortem C-Section
Case Writer: Clare Desmond, MD Peer Reviewer and Editor: Nikita Joshi, MD Keywords: Cardiac arrest, Perimortem C-section [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Sim Case Series: Incorporating ABEM Milestones
In this week’s simulation case, you will notice the addition of a table which is a description of ABEM Milestone #9 – General approach to Procedures (PC9). I created this table after attending a workshop from Dr. Danielle Hart (Assistant Residency Director and Director of Simulation at Hennepin County Medical Center). During the 2013 CORD assembly in Denver, Dr. Hart held a session in which she described a novel method by which to incorporate the ABEM milestones into simulation cases. This would accomplish two things: Provide an evaluation tool for the learners Easily incorporate milestones to evaluate residents [+]
Trick of the Trade: Rapid Oral Phenytoin Loading in the ED
A 57-year-old male (75 kg) presents to the ED after a witnessed seizure. He describes a history of seizure disorder and is prescribed phenytoin, but recently ran out. A level is sent and, not surprisingly, results as < 3 mcg/mL (negative). After a complete workup, the decision is made to ‘load’ him with phenytoin 1 gm and discharge him with a prescription to resume phenytoin. An IV was not placed. Can you rapidly load him orally? [+]
Be a great speaker: 10 practical pearls (part 5 of 5)
For the CORD Distinguished Educator’s Coaching Program, Dr. Gus Garmel has kindly offered to share his top 50 points to improve one’s speaking skills. These tips are great for anyone who plans to do public speaking. Thus far, this “be a great speaker” series has reviewed 40 pearls. [+]