• Pocket Contents

What’s in your pocket on an ED shift?

By |Dec 18, 2009|Categories: Life|Tags: |

I am always curious about what people carry in their scrubs and lab coat pockets. Often you can identify residents based on what they are carrying or wearing. Stereotypically, I find the following: Long reflex hammer jutting way out of the lab coat pocket – Neurology Plaster smears on their scrub tops and bottoms – Orthopedics Fluffy animal on their stethoscope and/or lab coat – Pediatrics LMP wheel – Obstetrics/Gynecology Small textbook in lab coat pocket – a medical student [+]

  • Laryngoscope Grip

Trick of the Trade: Laryngoscope lifting strength

By |Dec 16, 2009|Categories: Tricks of the Trade|Tags: |

You are about to endotracheally intubate a patient. As you struggle to elevate the laryngoscope more anteriorly, has your left hand ever trembled while trying to see the vocal cords? Before you say, “I think the cords are too anterior, hand me the [insert your favorite backup airway adjunct]”, let’s focus on some basics. How can you gain significantly more laryngoscope lift strength? You can do more left arm bicep/tricep exercises, or… [+]

Tricks of the Trade: Diagnosing retinal detachment with ultrasound

By |Dec 9, 2009|Categories: Ophthalmology, Tricks of the Trade, Ultrasound|

In a sneak peek of my ACEP News’ Tricks of the Trade column, Dr. Patrick Lenaghan, Dr. Ralph Wang, and I will discuss how bedside ultrasonography can significantly improve your ocular exam. Here is a classic example. A patient presents with acute onset right eye pain and blurry vision. She possibly has a field cut in her vision. Her pupils are a teeny 2 mm in size in the brightly-lit Emergency Department. You are having a hard time getting a good fundoscopic exam to comfortably rule-out a retinal detachment. [+]

  • Ernie Wang

Faculty hero: Ernest Wang (part 2)

By |Dec 8, 2009|Categories: Life|Tags: |

  Clinical Assistant Professor, NorthShore University HealthSystemAcademic Director, Center for Simulation Technology & Academic Research (CSTAR)Associate Program Director, University of Chicago EM Residency [+]

Article review: Neuro exam documentation

By |Dec 7, 2009|Categories: Education Articles, Medical Education, Neurology|

Medicolegal woes often can be tracked back to poor documentation by the physician. This article is a retrospective chart review of 384 EM resident charts, focusing on the documentation of the neurologic exam. Charts were selected if their chief complaints were neurologic or psychiatric in nature. A non-validated measurement tool for evaluating a neurologic exam was created based on discussions with attending emergency physicians. I have to agree with the chosen criteria. Documentation in each of the following criterion receives 1 point for a maximum score of 8. [+]

  • Finger In Fossa

Trick of the Trade: Subclavian line gone north

By |Dec 2, 2009|Categories: Tricks of the Trade|Tags: |

In patients requiring central venous access, which vein do you prefer? In descending order, I prefer subclavians, internal jugulars (IJ), and then femorals. There is increasing evidence that subclavian central venous lines are superior to femoral lines (JAMA 2001) with respect to iatrogenic infection and thrombosis rates. In 9% of subclavian lines, however, the line tip ends up in the ipsilateral IJ, instead of the superior vena cava (SVC) – see chest xray below. These lines are unusable in the long term because of the risk of cathether thrombosis in this low-flow area. The line must must be rewired. [+]

Faculty hero: Ernest Wang (part 1)

By |Dec 1, 2009|Categories: Life|Tags: |

Ernest Wang, MD Clinical Assistant Professor, NorthShore University HealthSystem Academic Director, Center for Simulation Technology & Academic Research (CSTAR)Associate Program Director, University of Chicago EM Residency [+]

Article Review: Hidden cost of reducing resident duty hours

By |Nov 30, 2009|Categories: Education Articles, Medical Education|Tags: |

Patient care versus education This is the tug-of-war struggle that residency programs constantly grapple with. Residents work in an apprenticeship model where they are both patient providers and learners. Both are critical in residency training, but they sometimes negatively impact each other. For instance, EM residents hand-off their patients to covering residents while attending their weekly conference classes. In contrast, residents may skip that day’s board teaching rounds to manage an acutely decompensating patient. [+]

  • Humming US

Trick of the Trade: Hum-out the jugular veins

By |Nov 25, 2009|Categories: Tricks of the Trade|Tags: |

Placing an IV in the external jugular vein requires venous distension maneuvers. This means having the patient perform a Valsalva maneuver or be placed in a Trendelenburg position. Have you ever had a patient who didn’t quite get the Valsalva maneuver concept, or couldn’t tolerate a head-down position? [+]

  • graduation cap

Article review: Commentary on graduate medical education in the U.S.

By |Nov 23, 2009|Categories: Education Articles, Medical Education|Tags: |

“How ready are medical students for the clinical practice of medicine?” This was the question addressed by the landmark 1910 Flexner Report from the Carnegie Foundation for the Advancement of Teaching. Back in the early 1900’s, residency training did not exist yet, and students entered clinical practice immediately after graduation from medical school. The quality of medical training varied significantly with alarming deficiencies in many medical schools. An independent, nonprofessional organization was commissioned to report about the situation in order to pressure the public to reform medical school education. [+]