Paucis Verbis: CHF likelihood ratios
A 50 y/o man with a history of CHF and COPD is brought in by ambulance in severe respiratory distress. He is sitting upright with a RR 30 and O2 saturation of 79% on room air. Is this a CHF or COPD exacerbation? This is a common dilemma faced in the ED. Fortunately there are likelihood ratios to help you risk stratify using a Fagan nomogram. Note that there are 3 tables: All-comer Emergency Department (ED) patients1 ED patients WITH a known history of asthma or COPD2 Summative LRs for BNP are provided in ED patients with or without a history of asthma/COPD1 [+]
Filter it: Keeping up with digital information overload
I haven’t found a way of keeping up with all the information out there, even with textbook reading. I don’t know if there is way. Here are my thoughts. [+]
Director of Growth, Strategic Alliance Initiative, [+]
Trick of the Trade: Alternative to Word catheter for Bartholin abscess
Bartholin abscesses are challenging to manage, partly because of Word catheter insertion. Sometimes, the space is not large enough (unable to fit the catheter) or too large (catheter falls out). How else can you “pack” the abscess space? [+]
Peeing into the wind? Urine drug screens, part 1 (benzodiazepines)
Let’s be honest. When was the last time results from urine drug screens (UDS) changed your management plan? Many times it takes hours for the patient to give the urine sample anyway. And, with all of the false positives out there, how do we know what the heck the result is actually telling us? [+]
Paucis Verbis: Does this adult patient need blood cultures?
Do you order blood cultures for all your ED patients with a fever? Obviously no. What's your decision making process on ordering this test? There are really no findings or tests with high specificity (rules-IN bacteremia), except interestingly "shaking chills". Notice almost all the criteria listed below approach a likelihood ratio (LR) of 1.0. Two prediction rules do exist, however, to help you virtually rule-OUT bacteremia: SIRS Shapiro prediction rule The list of LRs also will be helpful to show learners in the ED that an isolated serum WBC number is useless risk-stratifier. Patient Case A 55 y/o man with [+]
Trick of the Trade: Incision and loop drainage of abscesses
Why are we still teaching the traditional incision and drainage approach to simple abscess drainage? They require frequent, painful packing changes to ensure persistent drainage of retained pus. Trick of the Trade Incision and loop drainage (I&LD) technique As per usual, Dr. Rob Orman (ercast) beat me to this. He already reviewed the technique on his blog in 2010. This stems from a landmark article in the Journal of Pediatric Surgery, which involves creating a persistently draining fistula at two points by using a small vascular loop, tied into a non-tensile loop. It makes sense to extrapolate and use this [+]
RIP: Ode to my textbooks
If you were to take a look at my bookcases, you would classify me as a book hoarder. Yes, it’s true I have been collecting book. Some have been with me since college. Books have so much information, and I have always felt a bit paranoid about throwing them away and then not having them for a critical piece of information that I need. [+]
Paucis Verbis: Overanticoagulation and supratherapeutic INR
I find it amazing that I know more non-emergency physicians virtually in the social media world rather than in person. Primarily through Twitter, I follow and am followed by medical educators from various specialties. If you haven't joined Twitter yet, I think it might be time. There is a whole world of collaboration and conversation going on in this virtual community, which crosses specialties and geography. Last week, Dr. Javier Benítez (@jvrbntz) was tweeting a Question of the Day, referencing a 2010 Paucis Verbis card on overanticoagulation, which was based on the 2008 American College of Chest Physicians (ACCP) guidelines. [+]
Mythbuster: The 10% cephalosporin-penicillin cross-reactivity risk
To give or not to give a cephalosporin in penicillin-allergic patients? I remember back to my days in pharmacy school when I learned that there was approximately a 10% risk of cross-reactivity, if a cephalosporin was given to a penicillin-allergic patient. They probably said something about the risk being less with 3rd and 4th generations cephalosporins, but lets be honest… who remembers anything but that magic 10%? When I started working more with physicians, I found that they also learned the same 10% rule in medical school. Well, I guess that means it’s fact, right? Not so fast! [+]
Welcome to the blog team: Bryan Hayes, PharmD
Have you been reading the mind-blowing pearls on Twitter by Bryan Hayes, PharmD, DABAT? He is taking world of ED pharmacology and toxicology by storm on Twitter as @PharmERToxGuy. If have not been following him, you are missing out. I usually end up hitting “favorite” for all of his tweets to review again later. So for purely selfish reasons, I asked Bryan to see if he’d be willing to expand his 140 character gems on this blog. Much to my delight, he said yes! [+]