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 [+]
Poster resource: Better posters blog
I am in the midst of generating posters for the Canadian Association of Emergency Physicians (CAEP) conference. My residents and I came across this resourceful site about making them. Better Posters http://betterposters.blogspot.com/ [+]
Director of [+]
Trick of the trade: Improve your ability to detect a cerebellar lesion
The finger-to-nose exam is typically used to detect a cerebellar lesion. In subtle cases though, this can be be difficult to detect. How can you improve your sensitivity of this exam? Trick of the trade: Elbows up! [+]
Article review: Clinician attitudes about commercial support of CME
Did you know that a cup of coffee can cost over $9… when planning a CME conference? In an interesting survey-based publication by Dr. Tabas (one of my colleagues) that just came out in Archives of Internal Medicine, we learn more about the ins and outs of CME activities. The authors set out to determine the audience members’ opinions about: Commercial/ pharmaceutical support and its impact on bias Their willingness to pay extra conference registration fees to eliminate outside support [+]