Social media in academia: Why do it?
“Why would I want to participate in Twitter and social media?” This is a common question that I get from my fellow emergency physicians. They think that social media applications are for people who have nothing better to do than to read/write about trivial personal opinions. [+]
Trick of the Trade: Fingertip injuries
Fingertips can get injured in a variety of ways such as machetes, meat grinders, and broken glass. You name it, and we’ve probably seen it. Some don’t actually need anything invasive done because the skin is basically just torn off. The wound just needs to be irrigated, explored, and then bandaged to allow for secondary wound closure. What do you do if the finger injury keeps oozing and the finger tip is too painful for the patient to apply firm pressure? Poking the finger with 2 needles to perform a digital block seems a bit overkill. [+]
SAEM National Meeting a success!
The national SAEM meeting in Boston just concluded and was a success. As part of the SAEM Social Media Committee, I was encouraged to see how many people were tweeting events from the meeting. Check out the tweets with the #SAEM11 hashtag. To view beyond the most recent 100 tweets, you can view here.
Paucis Verbis: Pulmonary Embolism Clinical Prediction Rules
"Should I get a D-Dimer test or CT chest angiogram on my patient with atypical chest pain to rule-out a pulmonary embolism?" This is a common question asked by emergency physicians on a routine basis. Here are 3 clinical prediction rules: PERC, Wells, and Simplified Geneva Score. Personally, I've never used the Geneva Score, but it's worth looking at. A WORD of CAUTION These rules should be used with caution, because none of these scoring protocols are perfect. For instance, in a recent publication in the Journal of Thrombosis and Haemostasis, the authors found that the PERC rule does not actually [+]
Internet CME: EMedHome.com
Two weeks before renewing your license, you realize that you’re short 7 CME credits. Uh-oh…what to do now? Unfortunately, not enough time to go to a conference. Reading always gets boring after a while. Lie on your renewal application (NOT!)? If only there was a one-stop method of getting a variety of CME to keep you interested. [+]
Tricks of the Trade: Tea bags to the rescue
I have heard of using tea bags under your eyes to reduce puffiness, but to combat odors in the ED? In my growing list of “Tricks of the Trade” tips for protecting your olfactory nerves (Antacid booties for toxic sock syndrome, aerosolized orange juice, abscess drainage using suction), I got a clinical gem from Dr. James Juarez (Rogue Valley Medical Center in Ashland, OR) after my recent Tricks of the Trade talk at High Risk EM in San Francisco. [+]
Article review: Improving case presentations with theater training
"To be or not to be?" What could be more strange on a medical school curriculum than a theater training course? The authors of this study in Medical Humanities innovatively designed a 1-week elective course to help medical students at Mayo Medical School to improve their case presentation skills in partnership with the Guthrie Theater. In this pilot course, seven medical students (six 1st year students, one 4th year student) participated. The learning objectives were: Hear stories: those told by patients, colleagues and in written narratives Identify the elements of a narrative, and examine stories for narrative structure Share stories: through case [+]
Paucis Verbis: Outpatient treatment for diverticulitis
The classic prior teaching for the treatment of diverticulitis includes: Hospital admission Bowel rest (NPO) IV fluids Broad spectrum IV antibiotics Do ALL patients need to be admitted? There is some early literature suggesting that there is a small sub-population who fare well with outpatient treatment. This article from Annals of EM in the "Best Available Evidence" series summarizes the existing literature well. PV Card: Diverticulitis Adapted from [1] Go to ALiEM (PV) Cards for more resources. Word of caution This paper only provides guidelines, based on the limited evidence out there. Still use your common sense. For instance, I'd [+]
Trick of the Trade: Ring removal from a finger
A patient presents with a swollen finger after falling and fracturing it. The patient is more distraught by the fact that she can’t get the ring off her finger. She implores you not to cut the ring off. There are textbook chapters written about tightly wrapping the digit with string from distal-to-proximal and sliding the string under the ring. Theoretically, the provider can pull and unwind the proximal end of the string to gradually coax the ring over the coils of string. I have personally found little luck with this maneuver. [+]
Paucis Verbis: International Registry on Aortic Dissection (IRAD)
What do these 3 people have in common? Lucille Ball (comedienne) Jonathan Larson (wrote the musical "Rent") John Ritter (comedian) They all died from an aortic dissection. We commonly consider this diagnosis for Emergency Department patients presenting with severe chest pain. There is an International Registry on Aortic Dissection which published a retrospective, descriptive study of 464 patients with dissections. I find this list helpful, because it illustrates the fact that the classic signs and symptoms aren't actually very common. Here are some scary examples: A pulse deficit in the carotid, brachial, and femoral arteries is only present 15% of [+]