Physical exams: A relic of the past?
Why do most of us dread patients who complain of dizziness in the ED? Because it is so vague, and the differential is so broad from elusive posterior cerebellar strokes to ear wax clogging up our ear canals. And this is one of those diagnoses where the differential really depends upon performing a thorough physical examination. Think really hard, when is the last time you focused upon getting a complete and accurate physical examination? In medical school, there are courses dedicated to the art. I always laugh when I think of my neurology attending who just loved to bang on [+]
Twitter is the digital watercooler in Medicine
I just don’t have time to join Twitter. Are you serious, Twitter? Being in the minority of medical providers who use Twitter for work, these are common responses I hear. I would make the counter argument that it has given me opportunities to learn, collaborate, and share on a much more efficient level. [+]
Patwari Academy videos: ACLS and post-resuscitation care
This is the last installment of Dr. Rahul Patwari’s digital whiteboard video talks on ACLS, specifically focusing on post-resuscitation care and therapeutic hypothermia. Parts 1-3 (ACLS and airway) Parts 4-6 (ACLS: cardiac arrest) Parts 7-10 (ACLS: bradycardias and tachycardias) [+]
To debrief or not?
Learners have limited time. Residents have work hours restrictions, practicing physicians have work / life demands, and the list goes on. Time is valuable. Therefore, educational interventions must be hard-hitting, effective, and worthwhile. We discussed previously “What is debriefing?” Debriefing is a facilitated discussion and reflection about objectives previously chosen by the educator. Dr. Ernest Wang (NorthShore Center for Simulation and Innovation) states that it’s about getting learners to that “aha!” moment. [+]
PV card: Metacarpal fractures
Patients with rotation deformities of the fingers from a metacarpal fracture should be reduced. All fingers should normally point towards the patient's scaphoid bone. Metacarpal (MC) fractures are common injuries, which often spark discussions about whether they should be reduced in the ED urgently. What are the criteria for acceptable degrees of angulation? Are these criteria different for the MC neck versus shaft? Which fractures tend to be unstable and thus require eventual operative repair? How should I splint the injury? Here's a quick-reference card to help guide your management decisions. These recommendations may vary slightly based on what references [+]
Trick of the Trade: Speed up ECG paper rate to differentiate tachycardias
Undifferentiated tachycardias, especially when the rate is extremely fast, make it difficult to see anything other than the QRS complexes! Is there a P or flutter wave? [+]
Director of Growth, Strategic Alliance Initiative, Center for [+]
Patwari Academy videos: ACLS (parts 7-10)
What is the definition of bradycardia and tachycardia in the 2010 ACLS guidelines, for the purposes of resuscitation algorithms? Bradycardia: heart rate < 50 bpm Tachycardia: heart rate > 150 bpm [+]
Director of Growth, Strategic [+]
Teaching internationally: More than just a language barrier
I recently traveled to San Salvador to help teach a pediatric and adult ultrasound course. The course was well received and it was wonderful traveling around San Salvador. I wanted to share some of our experiences, and discuss some challenges to educating internationally. More importantly, I want to engage you, the readers to share some of your experiences when educating internationally as well. [+]
Is the 6-12-12 adenosine approach always correct?
The ACLS-recommended dosing strategy of 6 mg, 12 mg, and 12 mg for adenosine may not be appropriate in every situation. There are a few instances when lower or higher dosing should be considered. Caveat: All recommendations are data-based, but many factors affect successful conversion of paroxysmal supraventricular tachycardia (PSVT) including proper line placement and administration technique. [+]
Poll: How would manage a metacarpal fracture in the ED?
I am in the process of creating a PV card on metacarpal fractures, divided into anatomical areas (base, shaft, neck, head), and am realizing that the EM and orthopedic literature don’t quite agree. Actually they are quite vague on whether reductions should occur in the ED vs orthopedics clinic in the next few days. Do you need to close-reduce all angulated fractures in the ED, which are outside of “acceptable” angulations? What exactly are “acceptable” angulations? Some sources say that angulations of 10, 20, 30, and 40 degrees are acceptable for MC neck fractures and only 10, 10, 20, and [+]