Paucis Verbis: Toxic alcohols – Methanol
Continuing on the theme of Toxic Alcohols (osmolal gap, ethylene glycol), this Paucis Verbis card focuses on methanol toxicity. Useful are the American Academy of Clinical Toxicologists recommendations on when to administer an antidote (fomipezole) and when to perform hemodialysis. I redrew the flowchart based on what’s relevant to the ED in the initial stages. [+]
Trick of the Trade: "Punch out" the foreign body
A patient re-presents to the Emergency Department with a foreign body sensation in his heel after stepping on a broken window. Despite a negative xray and bedside ultrasound yesterday, the patient still believes that a small foreign body is still in there. You are unable to find a foreign body despite excising the overlying skin with a scalpel and exploring with forceps. [+]
Paucis Verbis: Toxic alcohols – Ethylene glycol
Following last week's Paucis Verbis card on calculating the osmolal gap, here is the first installment of the Toxic Alcohols cards. First up -- ethylene glycol. There are useful American Academy of Clinical Toxicologists recommendations on when to administer an antidote (fomipezole) and when to perform hemodialysis. Here's a quick review of the metabolism of the different toxic alcohols. The parent compounds for ethylene glycol and methanol are innocuous and the metabolites are toxic. PV Card: Ethylene Glycol Toxicity Adapted from [1-3] Go to ALiEM (PV) Cards for more resources. See Dr. Leon Gussow's great review on The Poison Review and tips [+]
Trick of the Trade: Hair tourniquet release
A 3 month old baby presents with distal erythema and swelling of one of her toes. A hair tourniquet is identified. Typically one can try manually unwrapping the tourniquet using forceps, but often only part of the tourniquet can be removed. The distal toe remains swollen and erythematous with delayed capillary refill. As demonstrated by the image above, it can be difficult to identify the hair because of the edema and the thin nature of the hair (especially if the same as the patient’s skin color). In a 2006 review of hair tourniquets in the Annals of Plastic Surgery, they [+]
Paucis Verbis: Approach to increased osmolal gap
We often talk about calculating the anion gap in the evaluation of patients. What about the osmolal gap? When do you calculate this? What's the differential diagnosis for an increased gap? I recently came upon a nice 2011 review in the American Journal of Kidney Disease called "Approach to the evaluation of a patient with an increased serum osmolal gap and high-anion-gap metabolic acidosis". It's always nice to revisit and review this concept. You'll always learn something new. For instance, I didn't know that salicylates cause anion gaps as well as osmolal gaps. So don't forget to calculate an osmolal gap [+]
Survey: Why do you use Twitter?
I recently got a comment on the blog asking why people need to use Twitter, if they're already following blogs. I thought I would open this up to the blogosphere. I personally use my Twitter account (@M_Lin) for a variety of reasons: I tweet the link to my blog whenever there is a new post (I just tweeted a link to this post!) Scan quick, real-time information from clinicians I trust Know "what's hot" in EM, medical education, and education technologies Learn of new blogs and websites which I didn't know about Quickly check tweets on-the-fly on my iPhone during [+]
Trick of the Trade: Mark your sites with a Sharpie
Marking the surface anatomy for procedures can significantly increase your chances for success, such as for lumbar punctures and central lines. I can never seem to find surgical skin markers. [+]
Director of Growth, Strategic Alliance [+]
Twitter conference notes: High Risk EM and Gaming Symposium
Yesterday, I attended two fantastic conferences and so wasn’t able to make a new Paucis Verbis card: UCSF High Risk Emergency Medicine UCSF Gaming and Learning Symposium [+]
Director of Growth, Strategic Alliance Initiative, Center for [+]
Trick of the Trade: Ear foreign body
Sometimes classic techniques need to be revisited, especially when I get new photos from the collective readership. Let’s review a painless way to remove beads from the ear canal. You can’t exactly have the patient’s provider blow in the other ear to expulse the bead, similar to a nasal foreign body… [+]
Paucis Verbis: Upper GI bleeding
Do you know what the Blatchford clinical prediction score is for upper GI bleeding? It can help you predict whether a patient with an upper GI bleed is severe and requires urgent intervention. Hot off the presses, JAMA just came out with a great Clinical Rational Examination article on this topic. Thanks to Dr. Ryan Radecki (EMLitOfNote) for the heads up. The likelihood ratios and Blatchford risk stratification score are so useful that I'm breaking my PV rule to keep things down to the size of one index card. Note the absence of a NG lavage result to help you [+]