Modern EM: Case #4 – Palpitations
Case # 4: Palpitations A 25 year old woman presents with palpitations, sweating, and shortness of breath since this morning. 6 days ago she had syncopized, was shocked out of V-tach by EMS, and eventually had a defibrillator placed for an unknown arrhythmia. Now, she feels her heart beating in her chest, looks diaphoretic, is tachypnic, but her pulse is 58 and regular. [+]
Hot off the Press: Talking about Web 2.0 in Emergency Medicine
I am humbled to be included and quoted in a recent Annals of EM commentary about Web 2.0 in Emergency Medicine. Hey, my "street credibility" just went up just by having my name in the same article with the likes of: Mike Cadogan (Life in the Fast Lane) Joe Lex (Free Emergency Medicine Talks) Chris Nickson (Life in the Fast Lane) Cliff Reid (ResusMe) Scott Weingart (EMCrit) You can read the whole article, which is free to download by the journal.
Modern EM: Case 3- Get your phones out
Sometimes on off-service morning table rounds, I like to close my tired eyes and focus my ears past the voice of the attending to hear the chorus of hundreds of pieces of paper flipping, shuffling, crinkling, and folding. It’s one way to pass the time when surgeons debate over issues they don’t already know the answers to. Another is to get your phone out, and help answer the questions with them. [+]
Trick of the Trade: Fluorescein eyedrops
This is a guest post by Dr. Ian Brown (Stanford): The Roberts textbook describes the procedure of corneal fluorescein staining as touching a moistened fluorescein strip to the cornea. Maybe it is an irrational fear of a paper cut to the sclera, or a fear of touching an already abraded cornea with the paper, but I try to find an alternative. I have seen physicians hold the eye open with one hand, hold the fluorescein with a second hand and then drip tetracaine on the paper and let it drip into the eye with a third hand. I, unfortunately, only [+]
Modern EM: Case 1 and 2 – Strep Throat
A sister and brother, aged 7 and 14, respectively present with pharyngitis. The 7F has sore throat, cough, fever, and post-tussive vomiting for 1 day. She has posterior pharyngeal erythema, no lymphadenopathy, no exudate, no petechiae, and looks like a viral URI. The 14M had culture confirmed GAS pharyngitis 3 weeks ago, was treated with PCN-VK and symptoms resolved. Now, he’s in the ED with signs and symptoms of pharyngitis again, including dysphagia, fever, cough, posterior pharyngeal erythema, swollen tonsils, LAD, and petechiae on his hard palate. [+]
Introducing a new blog: "Modern EM"
Last month, I announced Dr. Timothy Peck (Beth Israel Deaconess EM resident) as one of the winners of the Blog Incubator Contest. Starting today and for the next 2 Mondays, he'll be posting a 3-part series, which will eventually end up on his blog "Modern EM" at ModernEM.blogspot.com. His blog will feature examples of how Web 2.0 influenced the management of specific patient encounters. Also guests will be allowed to contribute mini-case presentations where they will report how a Web 2.0 activity changed how they managed a patient. The blog is still in development phase. In the meantime, you are [+]
Paucis Verbis: Kawasaki Disease
Kawasaki Disease can be easy to diagnose when you have the pediatric patient, who presents with all 5 of the classic clinical findings. What happens when you have the prerequisite fever for ≥5 days, but only 2-3 clinical criteria? What ARE the 5 classic findings? When do you do waitful watching? When do you perform an echo? When do you treat empirically? Check out the nice flowchart below which addresses these questions. They summarize the most recent (2004) American Heart Association's consensus group's recommendations. PV Card: Kawasaki Disease (AHA 2004) Adapted from [1] Go to ALiEM (PV) Cards for more [+]
Trick of the Trade: Pelvic speculum for peritonsillar abscess
Peritonsillar abscess drainage in the ED continues to be one of my favorite procedures to perform. There are several tricks to increase your chances for a successful aspiration. One trick involves using a curved laryngoscope to help depress the tongue AND provide a bright light source. What if you don’t have a laryngoscope readily available? [+]
Video: Khan Academy and digital whiteboards
Dr. Rob Rogers (University of Maryland) is at it again with another brilliant installment of his Medical Education Videos. This 10-minute video covers the Khan Academy and how you too can create an interactive digital whiteboard for education. He talks about Doceri ($50 single-user access) and Splashtop ($19.99 for the iPad app). [+]
Trick of the Trade: Irrigation fluid is key – but not in your eye!
High pressure irrigation of wounds is critical in reducing the rate of wound infection. There are a variety of commercial irrigation kits which include splash guards. If you are irrigating correctly and generating at least 8 PSI of pressure, some irrigation fluid should splash up and out of the wound. Be careful not to splash irrigation fluid in your eyes. What if you don’t have a commercial irrigation setup? [+]