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? [+]
Paucis Verbis: Post-exposure prophylaxis (non-occupational)
You know how chief complaints present to the ED in multiples? In one week, I had several cases where patients were asking for post-exposure prophylaxis treatment NOT in the content of a sexual assault. I haven't had to manage such cases in a long time and so needed to look up the recent guidelines from the CDC.1 The trick is not to forget about all the co-existing problems and infections beyond just HIV. Specifically, don't forget about gonorrhea, chlamydia, and trichomonas. PV Card: Post-Exposure Prophylaxis for Non-Occupational Contact Adapted from [2] Go to ALiEM (PV) Cards for more resources. [+]
What’s your perfect idea for a medical app?
The American Medical Association (AMA) is harnassing the innovative power of the people in its “AMA App Challenge”. What do you think would be the perfect app for medical students, residents, and/or practicing physicians in their day-to-day life? This challenge is the perfect opportunity for all those with great app ideas but are too busy (or lazy) to do the technical, legal, and business groundwork to make the idea a reality. The down side is that once you submit the idea, AMA has full proprietary ownership of it. [+]
Trick of the Trade: Steristrip-suture combo for thin skin lacerations
Lacerations of elderly patients or chronic corticosteroid users can be a challenge because they often have very thin skin. Sutures can tear through the fragile skin. Tissue adhesives may not adequately close the typically irregularly-edged laceration. How do you repair these lacerations? Do you just slap a band-aid on it? [+]
Nancy Duarte at TedxEast: The anatomy of a great speech
Nancy Duarte, the author of “Resonate — Present Visual Stories that Transform Audiences” and CEO of Duarte Design, recently gave a talk at TedxEast. The title was: You Can Change The World [+]
Director of Growth, [+]
Article Review: Role of instructional technologies in medical education
A conference called "A 2020 Vision of Faculty Development Across the Medical Education Continuum" was held at Baylor College of Medicine in 2010. At this conference, experts convened to discuss the changing role of technologies in medical education. Their conclusions were summarized in this Academic Medicine article, which discusses 5 trends and 5 recommendations. Trends Explosion of new information: It has been postulated that the world's body of knowledge will double every 35 days by 2015. We are in an age of information explosion. Physicians will have to be able to process an ongoing onslaught of information throughout their career. Learning how [+]
Paucis Verbis: Chemical sedation for severe agitation
Haldol, Ativan, and Versed... oh my. In the Emergency Department, some patients present very acutely and aggressively agitated. This is usually the result of illicit drug use or a schizophrenic who hasn't been taking medications (or both!). Fortunately, we have an arsenal of medications to help sedate the patient. One study looked to answer the question of what single IM sedation agent is most effective, as measured by the shortest time to sedation and time to arousal. PV Card: Chemical Sedation for Agitation Adapted from [1] Go to ALiEM (PV) Cards for more resources. Reference Nobay F, Simon BC, [+]