Trick of the Trade: A removable guidewire
An essential skill of any innovative troubleshooter in the Emergency Department is the ability to recognize when one piece of equipment may be used elsewhere. For instance, what’s your go-to approach when looking for a spare guidewire? Let’s say you are trying to salvage an ultrasound-guided basilic vein IV catheterization. Here’s where I go for guidewires: Central line kits Pneumothorax pigtail kits Seldinger-based cricothyrotomy kits [+]
Blog Incubator Experiment: Be the next big thing in blogging
There are many health and technology incubators out there, which help to build start-up companies into thriving and profitable organizations. Why can’t we do this for those who are thinking about starting a blog? In 2009 when I was thinking about starting the blog, I had lots of support and encouragement. I slowly grew my readership by word-of-mouth and things really got going when the folks over at Life in the Fast Lane, Poison Review, EMCrit, and so many more graciously pointed their readers toward my site. [+]
Paucis Verbis: Serotonin syndrome
Background Serotonin syndrome is caused by the excess of serotonin and presents classically as: Altered mental status Autonomic instability Neuromuscular hyperactivity Fortunately, there's a nice algorithm (Hunter's decision rule) which helps you decide whether it is serotonin syndrome or not. I also include a table, which I adapted from a New England Journal of Medicine review article, which helps you to differentiate it from its mimickers, such as anticholinergic syndrome, neuroleptic malignant syndrome, and malignant hyperthermia. PV Card: Serotonin Syndrome Adapted from [1, 2] Go to ALiEM (PV) Cards for more resources. A video to remind you what clonus looks [+]
Trick of the Trade: Hip dislocation Part II
As a followup to the blog on the Captain Morgan technique for hip dislocations, I’d like to throw out another similar technique that also does NOT involve climbing up on the gurney. [+]
Director of Growth, [+]
Trick of the Trade: Tie-over dressing for scalp lacerations
Scalp lacerations are apparently a hot topic these days. This is the third post now on how to apply a bandage to a scalp laceration. Beanie hat using tubular gauze Hair braid dressing [+]
Director [+]
Trick of the Trade: Captain Morgan technique for hip dislocation
https://www.youtube.com/watch?v=WXN9RMjyn4M Relocation of a hip joint is often quite a sight to see in the ED. A commonly taught technique is the Allis maneuver (watch the first 45 seconds of the above video from the Medical College of Georgia). It has always seemed a bit precarious to me having someone stand on the patient’s bed. [+]
Paucis Verbis: Feedback card
Today's Paucis Verbis card is a little different. This card focuses on helping you give talking points when giving feedback to a learner on shift. This could be a medical student or resident. Dr. David Thompson (UCSF-San Francisco General Hospital) sent this great card to me and I thought it was too useful NOT to share. It's handy on shift, which ultimately is the purpose of these Paucis Verbis cards. These are useful especially for senior residents, who are supervising medical students and junior residents. This card can be used in many ways. For instance: Print these cards and fill [+]
Video: Social Media in Medicine – What is it and why?
From LifeInTheFastLane.com’s illustrious Dr. Mike Cadogan. These were the slides from his Social Media in Medicine talk at the recent USC Essentials Conference. It’s time more physicians get involved and join the conversations that are taking place on social media. Join now. [+]
Trick of the Trade: Bandaging the scalp laceration
Scalp lacerations are one of the most common injuries which present to the Emergency Department. Applying a dry bandage over the staples or sutures can be a challenge because the tape just has nothing to adhere to. We reviewed the use of tubular cotton gauze to create a beanie hat, but what should you do if you can’t find any tubular gauze? Ever since I wrote about the beanie hat trick, people in the ED have been using the tubular gauze more and we’re always out of stock whenever I look for it! [+]
Paucis Verbis: Acute vestibular syndrome and HINTS exam
What is your diagnostic approach to the acutely vertiginous patient? The bottom-line question is: Is the cause peripheral or central in etiology? In this great 2011 systematic review article in CMAJ on Acute Vestibular Syndrome (AVS), the authors review how (un)predictive elements of the history and physical exam are. By definition of AVS, symptoms must be continuous for at least 24 hours and have no focal neurologic deficits. Frighteningly, the authors report many of the signs and symptoms (type of dizziness, hearing loss, patterns of nystagmus, Hallpike-Dix) are not as predictive as we classically are taught! The take home point [+]