PE in pregnancy: which diagnostic tests do you use?
Pulmonary embolism (PE) can be a deadly disease and one of the most challenging diagnosis to make in a pregnant patient. Patients may present with signs and symptoms that might also be present in a normal uncomplicated pregnancy. Even in nonpregnant patients, the diagnosis of venous thromboembolism (VTE) such as PE can be quite challenging. [+]
Trick of the Trade: External jugular tourniquet
Paitents can be a challenge when trying to obtain peripheral IV access. The vein may be collapsed from dehydration or scarred because of IV drug use or repeated cannulation. Before thinking about an ultrasound-guided deep vein IV or a central line, take a look at the external jugular (EJ) vein. There are, however, a few problems that exist when trying to cannulate this site: There is no tourniquet for the neck. To distend the vein, you often need to put the patient in Trendelenburg, which may be uncomfortable or intolerable for some [+]
Patwari Academy videos: Trauma primary and secondary survey
What’s the primary and secondary survey in the assessment of the trauma patient? This is a great review of the methodical approach and insight in the thought processes by Dr. Rahul Patwari. [+]
Director of Growth, [+]
Simulation cases: How to write the storyboard
Last week I wrote about the important components in writing a simulation case. It is an exhausting list, but the thoroughness pays off. The next big task is writing the actual case storyboard, which can be done in many ways. All revolve around the concept of action and reaction. The key to a well written simulation case is understanding the actions that the learners will take, the actions that they should take, the actions they shouldn’t take. [+]
Built a 20-person worldwide educator panel in two hours
Yesterday I had the pleasure of sharing my thoughts to an enthusiastic crowd of UCSF preclinical medical students on one of my favorite topics “Technology and Social Media in Emergency Medicine”. This is the perfect target audience to teach about developing a workflow habit for keeping up with digital information, since they are only starting to grow their clinical knowledge foundation. On the morning of my noon talk, I regretted not recruiting some fellow FOAMed (Free Open Access Meducation) supporters to email me their thoughts about why social media is here to stay in medical education. How great would it have been to [+]
Trick of the Trade: Use the angiocatheter for central lines
Central lines come packed with a long introducer needle (pink arrow) to feed the guidewire through AND a long angiocatheter (yellow arrow). Most people cannulate the vein by using the syringe and the introducer needle. What’s the angiocatheter for? [+]
MOOC: Clinical problem solving with Dr. Lucey
According to Wikipedia, MOOC stands for Massive Open Online Course, was coined by Dave Cormier (@davecormier) in 2008 during a course called “Connectivism and Connective Knowledge” in a course led by George Siemens (@gsiemens) and Stephen Downes (@oldaily). All three are educators from Canada who specialize in online learning, learning and technology, and connectivism. As the name implies the course is open to thousands of people online. Although thousands of people sign up only a very small percentage finish the course. [+]
Writing a Medical Simulation Case
It can be a daunting task to write a medical simulation cases. Regardless of prior experience in simulation, writing cases is a different skill set than programming or working a high fidelity simulator. It’s more similar to writing a play– at times an impromptu play! What is a Medical Simulation Case? It usually entails a patient encounter with a healthcare provider (learner) where an event occurs, and the learner is expected to perform actions. After some time, or after certain actions are performed, the facilitator stops the simulation, and debriefing ensues. [+]
PV card: Bell’s Palsy Treatment
Bell's Palsy is an idiopathic unilateral facial nerve paralysis. Since the 2009 Cochrane review1 showing that antivirals added no benefit to corticosteroids in Bell's Palsy, I stopped prescribing them. The NNT.com site has concluded the same. Looking at the literature a little more, the recommendations are a little murkier. Some groups are still advocating for antivirals for severe cases, because there may be a very small but questionably positive benefit. "Because of the possibility of a modest increase in recovery, patients might be offered antivirals (in addition to steroids) (Level C). Patients offered antivirals should be counseled that a benefit from antivirals has [+]
Trick of Trade: Umbilical foreign body removal
Emergency physicians are constantly challenged with fishing foreign bodies out of various orifices such as ears, as shown here in an earlier Trick of the Trade using a tissue adhesive. What do you do when an overweight person presents with the cotton portion of a Q-tip lodged in his umbilicus? Skin retractors and direct probing were unsuccessful in removing the cotton. [+]