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, [+]
Trick of the Trade: Benzoin for opening traumatic, swollen eyelids
Patients who sustain facial trauma often have swollen eyelids. They may be so swollen that it is impossible to pull back the eyelids for an ocular exam. You use one of our “Tricks of the Trade”ideas and attempt to “roll” the upper eyelid using the Q-tip trick (above).Fresh blood on the face, however, makes the Q-tip a little slippery along the upper eyelid, preventing an adequate view of the eye itself. [+]
Article Review: Barriers to effective teaching
I think there is no better or more rewarding job than being an educator, especially in the field of Medicine. There are, however, significant financial, societal, curricular, and environmental barriers which prevent optimally effective teaching in Medicine. In a commentary piece in Academic Medicine, the authors review the barriers and some forward-thinking recommendations for our leaders in medical academia. While the focus of the article is on undergraduate medical education, many concepts apply to graduate medical education as well. [+]
Paucis Verbis: Strength of diagnostic tests for cholecystitis
You have a 40 year-old man who presents to the ED for persistent right upper quadrant abdominal pain for 12 hours after eating a fatty meal. He has no fevers, nausea, flank pain, or dysuria. His physical exam shows no fever and only moderate tenderness in the RUQ without guarding. He has a Murphy's sign which is improved after a total of 8 mg of IV morphine. His laboratory results, which include a WBC, liver function tests, lipase, and urinalysis, are normal. Can you safely say that the patient doesn't have cholecystitis? Can you discharge him for outpatient ultrasonography to [+]
Trick of the Trade: Topical anesthetic cream for cutaneous abscess drainage in children
Abscess drainage can be painful and time consuming in the ED. Can this article help? 1 Trick of the Trade Apply a topical anesthetic cream on skin abscesses prior to incision and drainage (I and D). In this press-released article in American Journal of Emergency Medicine, the authors found that application of a topical 4% lidocaine cream (LMX 4) was associated with spontaneous cutaneous abscess drainage in children. [+]
Article Review: Emergency physicians interruptions
What exactly do ED attendings do on shift? This novel prospective, time-motion study tracks the activities of ED attendings at 2 academic and 2 community sites. All sites used paper charting in the ED and computerized medical records for labs and radiology results. [+]
Paucis Verbis: Right and posterior ECG leads
A standard 12-lead ECG can be very telling for patients with chest pain or shortness of breath. A right ventricular (RV) and posterior wall infarct, however, can present very subtly. You can obtain special right-sided (V1R-V6R) and posterior leads (V7-V9), if you are concerned. What are the indications for obtaining right-sided and posterior ECG leads? Go to the ALiEM Cards for more resources. Addendum 3/11/11: Right sided ECG leads (V1R-V6R) are positioned in a mirror image fashion from the standard 12-lead precordial leads. Posterior ECG leads (V7-V9) are applied by moving V4-V6 in the posterior positions.
Trick of the Trade: Heat it up!
What is it about heat that makes everything feel better? Fireplace, hot tub, heat packs, electric blankets, and hot chocolate have got to be the best inventions EVER. How can we apply this in Medicine? [+]
Finding the right journal for your manuscript
When writing a manuscript, how do you choose what journal to submit to? You should factor in the journal’s impact factor and your manuscript content. At the recent CORD Academic Assembly meeting, I learned of a website which helps you decide your journal. JANE: Journal/Author Name Estimator [+]
Trick of the Trade: Website resource on HIV medications
At our department’s first annual UCSF High Risk Hawaii Conference 2 weeks ago, Dr. Rachel Chin taught about complications from all of the HIV drugs on the market now. It’s a virtual alphabet soup: EFV, TDF, FTC, oh my. How do you keep track of them all? [+]