Resuscitation 2012 conference
What are you doing the rest of this week? Hop on a plane to Las Vegas and join me at the 2012 Resuscitation conference. It looks to be a great conference. I'll be giving a 3-hour (!) discussion session on "Tips and Tricks in Emergency Medicine" on Friday. Inevitably when I given this talk, I always come away with great ideas from the audience. I'll be sure to write them down and share on the blog.
Trick of the Trade: Protecting your thumbs in mandible relocations
Does anyone think that this is generally a bad idea when closed-reducing mandible dislocations? Yes, it's easiest to apply downward pressure on the mandible by pushing down on the occlusal surfaces of the molar teeth. Sometimes, however, when the mandible relocates into place, the teeth clamp shut abruptly - placing your thumbs at risk. How can you prevent any injuries to yourself? One way is to slide gauze into the mouth during your procedure. Start the video around the 1:30 mark for an exam. Trick of the Trade: Mandible Relocations Apply a protective roll of gauze over each thumb. [+]
Paucis Verbis: Blunt Abdominal Injury, Likelihood Ratios
This month's issue of JAMA addresses the question "Does this patient have a blunt intra-abdominal injury?" as part of the always-popular Rational Clinical Examination series. The systematic review of the literature summarizes the accuracy of findings for your blunt trauma patient in diagnosing intra-abdominal injuries. Specifically, likelihood ratios (LR) are summarized. These LRs can be used to plot on the Bayes nomogram below. You draw a straight line connecting your pretest probability and the LR. This yields your posttest probability. The most predictive positive LR include: Abdominal rebound tenderness, a "seat belt sign", ED hypotension, hematocrit < 30%, AST or [+]
Trick of the Trade: Peritonsillar abscess aspiration technique using IV tubing
A few weeks ago, I gave a Tricks of the Trade talk for the Stanford-Kaiser Emergency Medicine residents and faculty. I was overwhelmed by the great, creative ideas that came up during our discussion. An always popular topic is the drainage of peritonsillar abscesses. Sometimes it can be difficult to aspirate from a syringe using only one hand, especially with the awkward angle that you might encounter. [+]
Paucis Verbis: GRACE score for ACS risk stratification
Risk stratification of the undifferentiated chest pain patients in the Emergency Department continues to plague emergency physicians. It's partly the reason why I created a TIMI risk score card for unstable angina and non-ST elevation MI in 2010. Have you heard of the 9-variable GRACE risk stratification score? Thanks to Jeff Bray (physician assistant in a rural critical access ED), I have now. He graciously shared his personal reference card on this with me, which I only minimally reformatted to fit my Paucis Verbis card dimensions. GRACE stands for Global Registry for Acute Coronary Events. It supposedly outperforms the TIMI [+]
Video: How to make a screencast video
A reader, Mark, posted a question yesterday in the chat box about screencapture softwares out there. I personally use iShowU to capture such videos as my instructional video on linking your Evernote account (above) to automatically read and download my weekly public Paucis Verbis notebook. Mark also specifically asked about what Dr. Rob Rogers (Univ of Maryland) uses. [+]
Trick of the Trade: Urine pregnancy test without urine
A 25 year old woman presents to the Emergency Department having syncopized in the waiting room, where she was triaged with the chief complaint of abdominal pain. Ectopic pregnancy immediately bubbles to the top of your differential diagnosis. The patient is too dizzy to walk to the bathroom to give you a urine specimen to check a urine pregnancy test. Plus, she admits that she just urinated in the waiting room bathroom a few minutes ago - so no urine now. Trick of the Trade Apply several drops of whole blood (instead of urine) into the pregnancy test cassette. In the [+]
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. [+]