ACEP 2012 meeting: Keeping up with Twitter
Are you at the 2012 American College of Emergency Physicians meeting in Denver this week? The who’s who of EM are there now teaching, learning, and networking. Here’s the moving video played at the opening session looking back at the Aurora mass casualty incident shooting. [+]
Trick of the Trade: IV ceftriaxone for gonorrhea
How many times have you given your patient IM ceftriaxone for that presumed gonococcal infection? ... still counting? Many of us learned (or at least thought we learned) that ceftriaxone has to be administered IM to get the ‘depot’ effect. Myth Busted There doesn't appear to be a true depot effect. IV and IM ceftriaxone have very similar pharmacokinetic profiles. Let me prove it to you, straight from the FDA-approved ceftriaxone package insert. Table 1: Average plasma concentration (mcg/mL) as measured over time after 500 mg of ceftriaxone administration Ceftriaxone route 0.5 hr 1 hr 2 hr 4 hr 6 hr 8 hr [+]
Trick of the Trade: Don’t miss the pneumothorax in needle thoracostomy
A patient arrives in PEA arrest and you note that her left chest has no breath sounds or lung sliding on bedside ultrasound. You suspect a tension pneumothorax. You insert a standard 14g angiocather in the left 2nd intercostal space (ICS). You don’t hear a rush of air. The patient’s clinical condition deteriorates to impending asystole. How sure are you that your angiocatheter actually reached the pleural space? [+]
Mythbuster: Pediatric coin ingestion vs aspiration?
Is this coin in the esophagus or the trachea? The classic teaching for the Boards exam is: Esophageal coins appear in the coronal plane, as shown above. Tracheal coins appear in the sagittal plane because of the cartilaginous tracheal rings. [+]
Trick of the Trade: Safer guidewire disposal
Have you ever accidentally flicked a drop of blood while disposing a straight guidewire into a rectangular sharps bin? The bins just don’t quite fit the wire easily. That’s just an occupational exposure just waiting to happen to yourself. [+]
PV Card: Electrolytes and ECG changes
The electrocardiogram can pick up all sorts of electrolyte abnormalities. The most common abnormalities revolve around high and low levels of potassium and calcium. Magnesium derangements typically have nonspecific findings. How do you keep things straight? To make things more complicated, multiple electrolyte derangements can occur at the same time, making ECG interpretation challenging. [+]
Creating a personal learning environment
What is digital curation? It is the selection, preservation, maintenance, collection and archiving of digital assets.1 Once you have curated the digital content you might want to share with others. There are different ways of sharing this content: Sending out the link Retweeting on Twitter “Like” on Facebook “1+” on Google+ Many others [+]
Hot off the press: Academic EM journal abstracts in Spanish
La revista Academic Emergency Medicine ha creado una nueva función en su página web en la cual todos los resúmenes de los articulos seran traducidos al espanol. Felicidades a AEM por ser la primera revista americana en emergenciologia y unas de las primeras en medicina general por tomar en cuenta a la población de idioma español. [+]
Trick of the Trade: A flexible pediatric ear curette
Having you had trouble seeing a pediatric patient’s tympanic membrane because of impacted cerumen? Scared from that last time you used a rigid curette and caused bleeding in the ear canal? The parents are worried that you hit the brain… [+]
Paucis Verbis: EMTALA rules in the transfer of ED patients
In U.S. academic emergency departments, decisions to accept patients is typically easy, because you have ready access to on-call physicians. When in doubt, accept transfer patients and sort things out later. What are the obligations for those transferring patients to other EDs? What do the EMTALA (a.k.a. "anti-dumping") rules say? When can you transfer unstable patients? As a general rule, the liability falls upon the transferring site and physician. So be sure that your patient won't decompensate in the ambulance during transfer. So, don't transfer that CP patient who is getting ruled-out for an MI or ACS no matter how good [+]