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! [+]
Top 10 reasons why Yoda would be a terrible mentor and teacher in medicine
This is based on an article from GeekWire that lists the top ten reasons why Yoda would make a terrible mentor and teacher. Let’s see if I can make a derivation and convert these reasons as to why Yoda would make a terrible mentor/teacher in medicine. [+]
Trick of the Trade: Ring removal using oxygen mask strap
Creative emergency physicians exist worldwide. Check out this nifty trick on ring removal by Dr. Simon Carley (Centre For Evidence Based Emergency Care at Manchester Metropolitan University) of St.Emlyns fame. [+]
Director of Growth, Strategic Alliance [+]
Conference: Faculty development and teaching course
The always-innovative, premiere educator Dr. Rob Rogers (Univ of Maryland) is hosting an international faculty development conference in November 2011. I’m guessing that this course is also open to U.S. physicians as well. [+]
Director of Growth, Strategic [+]
Sort me! Paucis Verbis cards now catalogued
After much recent feedback on the poll about the Paucis Verbis cards (thanks to all who responded!), I see trends: Several have commented that it is getting increasingly difficult to find a card that they are searching for. There are over 100 cards now! So, I managed to figure out how to embed a Google Doc spreadsheet into the blog, which now allows you to sort and search for particular cards (minor HTML coding necessary). This list will permanently live on the Paucis Verbis page. [+]