Trick of the trade: Nebulized … orange juice?
In my theme of detoxifying malodorous smells in the ED, I recently learned of a new way of masking odors. Imagine the stress on your olfactory nerves from the combined effects of urinary and fecal incontinence from a nursing home patient. An ingenious nurse proposed nebulizing actual coffee within the room. Unfortunately, our ED was out of coffee at the moment. [+]
Paucis Verbis: Dental infections
To follow up with the wildly popular Paucis Verbis card made by Dr. Hans Rosenberg (University of Ottawa), here is his card on Dental Infections. This card summarizes common dental infection complaints (like the periapical abscess seen to the right) that we see in the Emergency Department. PV Card: Dental Infections Adapted from [1] Go to ALiEM (PV) Cards for more resources. Reference Nguyen D, Martin J. Common dental infections in the primary care setting. Am Fam Physician. 2008;77(6):797-802. [PubMed]
Trick of the Trade: Corneal reflex test
The corneal reflex test (blink test) examines the reflex pathway involving cranial nerves V and VII. Classically the provider lightly touches a wisp of cotton on the patient’s cornea. This foreign body sensation should cause the patient to reflexively blink. This maneuver always makes me a little worried about causing a corneal abrasion, especially if you are examining a very somnolent patient. You are wondering — Is there no blinking because you’re not touching the cornea hard enough? You apply harder pressure but still no blink. You repeat the test and now the patient finally blinks. That’s 3 times you’ve [+]
First annual Medical Apps Awards: Vote now
The polls for the first annual Medical Apps Awards is now open. Voting closes April 21, 2011 @ 12:00 AM EST. General instructions (you can win various prizes) Go directly to the polls There are 3 categories that you can vote on: 1. Best Medical App for Healthcare Professionals MediBabble - a medical translation tool Doximity - a professional networking tool Medscape - comprehensive guide to drugs, interactions, diseases, & procedures Epocrates - comprehensive guide to drugs, interactions, identifying pills, & calculators DrChrono - the first EMR for the ipad 2. Best Medical App for Patients iHealth BPM w/ [+]
Article review: What’s wrong with self-guided learning?
There is a constant tug-of-war between self-guided learning and supervised learning. With the advances in technology for medical education such as asynchronous learning modules, simulation, there has been a movement away from traditional, instructor-led teaching and towards more independent, self-guided learning. There is less supervision of learning. But left unsupervised, are learners learning the right things and doing so optimally? The authors, in this review, say yes and no. [+]
Paucis Verbis: Dental trauma
How cool is this -- I have talented emergency physicians contributing Paucis Verbis card content! This week features excellent pearls on Dental Trauma by Dr. Hans Rosenberg (University of Ottawa). Here's his recent article in Annals of EM on reimplantation of avulsed teeth.1 PV Card: Dental Trauma Go to ALiEM (PV) Cards for more resources. Reference Rosenberg H, Rosenberg H, Hickey M. Emergency management of a traumatic tooth avulsion. Ann Emerg Med. 2011;57(4):375-377. [PubMed]
Trick of the Trade: Oblique CXR to look for pneumothorax
Supine chest xrays have an extremely low sensitivity (12-24%) in detecting pneumothoraces. Because a pneumothorax layers anteriorly on an AP CXR film, the xray beam is perpendicular rather than tangential to the pneumothorax edge. This makes visualizing a small to moderate sized pneumothorax extremely difficult. So you are left to look for indirect signs such as a deep sulcus at the costophrenic angle or subcutaneous air. I’m often surprised at how large of a pneumothorax can be missed on CXR based on CT imaging. The image to the right shows a large left-sided pneumothorax on CT. What if you [+]
Article Review: Medical education can learn from the neurobiology of learning
The brain is a mysterious thing. How do we learn? Can we apply what we know about the neurobiology and sociology of learning towards medical education? This review article in Academic Medicine presents 10 strategies to improve teaching and curricular development. [+]
Paucis Verbis: AMI and ECG Geography
Sometimes a picture is worth MORE than a 1000 words. Such is the case of the above illustration that I saw on the Life In The Fast Lane blog. When I first saw it, I knew that I immediately had to find out who made the graphic. It turns out it is the multitalented Dr. Tor Ercleve, who is an emergency physician at Sir Charles Gairdner Hospital and an established medical illustrator. This graphic demonstrates the EKG findings for the various types of acute MI's as broken down by coronary vascular anatomy (right coronary artery, left circumflex artery, left anterior descending [+]
Trick of the Trade: Check pupillary constriction with ultrasound
In some trauma patients with head and face trauma, you will need to check their pupillary response to light. Severe periorbital and eyelid swelling, however, make this difficult. You want to minimize multiple attempts to retract the eyelids because of the risk of a ruptured globe. What’s a minimally painful and traumatic way to check for pupillary constriction? [+]