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 [+]
Mini-guide to Twitter: Why should I join?
What is Twitter? It’s a social network where people can send messages of a maximum of 140 characters in real time. It was created in 2006, and it has grown tremendously ever since. When it was first created the messages, called tweets, were about what people were doing in real time. Nowadays people, or “tweeple” as they are called on Twitter, are tweeting about any subject in the world. Here’s is detailed guide on how to use Twitter by Albert Einstein College of Medicine. Slide 35 is a 7:47 minute video where Dr. Chretien, an internist, is interviewed about the [+]
Top 10 tweets about medical education
Here are my favorite 10 tweets in the recent Twitter world about medical education. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Tricks of the Trade: Calcium gel for hydrofluoric acid burns
A 41 y/o m presents to your ED after an occupational exposure to 30% hydrofluoric acid (HF). The thumb and index finger of his right hand were affected. Upon visual examination, the site of exposure looks relatively benign but the patient is complaining of extreme pain. Beyond giving opioids, what can you do? [+]
Diagnostic tests: Asking the right questions
You have picked up the next chart and have drawn your differential diagnosis based on the patient’s demographic, chief complaint, and vital signs. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and [+]
Do you know your resuscitation room?
When I was in medical school doing my critical care elective in EM, I remember seeing the interns preparing tubes and IVs before their shifts started. Since then it was instilled in me that coming early to the shift was essential to make sure that at least your resuscitation room was adequately set up for any major emergency coming through. With the help of a few friends, I made up a list of the equipment that should be present and working appropriately in your resuscitation room. [+]
Trick of the Trade: Pass the mayo – getting off black tar
Industrial accidents sometimes involve hot coal tar stuck to a patient’s skin. Coal tar is notoriously challenging to remove once it has cooled and adhered to the skin. The tradition teaching is to apply large quantities of petroleum jelly to the black tar, let it sit for at least 60 minutes, and then diligently try to rub away the tar. Repeat as needed. What if you don’t have any petroleum jelly or petroleum-based products? [+]
Paucis Verbis: Delayed sequence intubation
A 40-year-old man presents with significant agitation and severe respiratory distress from a COPD exacerbation. His oxygen saturation is 75% on room air, and he has diffuse, tight wheezes on exam. You prepare to intubate the patient using a rapid sequence induction protocol: etomidate, succinylcholine, 8-0 endotracheal tube. Or do you? This pocket card discusses the delayed sequence intubation (DSI) protocol made famous by Dr. Scott Weingart and Dr. Rich Levitan.1 Thanks to Dr. Michelle Reina (EM resident at Univ of Utah) and Dr. Rob (Intermountain Medical Center in Utah) for designing this helpful card. Rob has even implemented a DSI protocol in [+]
The 3-minute EM student presentation
One of the most helpful articles I’ve encountered on teaching oral clinical presentations in the ED is a paper from Academic EM in 2008. It summarizes how to teach the “3-minute EM student presentation.” [+]
Trick of the Trade: Oral naloxone for opioid-induced constipation
Opioids are amazingly effective for pain control. Patients on chronic opioids, however, often struggle with constipation. These patients may fail supportive treatment with enemas and laxatives. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation [+]