Hot off the press: Clinical practice guideline for ketamine in the ED
A 3 year old girl is brought into the ED with an abscess to her groin. Upon examination it is fluctuant and needs incision and drainage. Next door is a 5 year old boy, who fell off his bed and has an angulated radius fracture that needs reduction. Hhhmmmm…how to manage these patients? Local anesthesia? Hematoma block? Nothing (aka brutacaine)? What about ketamine, that seems popular these days. IV? IM? With or without atropine? So many decisions! Luckily you were surfing the internet one night and came across the 2011 clinical practice guideline on ketamine in the ED, which was [+]
Paucis Verbis: Pneumonia risk stratification tools
Pneumonia is a common cause for ED visits. How do you decide on whether the patient can be managed as an outpatient or inpatient? To supplement your clinical judgment, many clinicians use the Pneumonia Severity Index (PSI) score. Have you heard of CURB-65, supported by the British Thoracic Society? What about SMART-COP, which is meant to help you predict if your patient will need Intensive Respiratory or Vasopressor Support (IRVS)? PV Card: Risk Stratification Scoring Tools in Pneumonia Go to the ALiEM Cards for more resources.
Article Review: Professionalism of physicians on Twitter
In a Research Letter in JAMA, Dr. Chretien et al describe the profile of physicians in the Twitter universe, specifically focusing on professionalism.Inclusion criteria: Self identified physician At least 500 followers during May 1-31, 2010 (Whew, I only have 309 followers.) English tweets Posted a tweet within last 6 months [+]
Paucis Verbis: Assessing patients with suicidality in the ED
Dr. Rob Orman emailed me last week about creating a pocket card on Suicide Risk Stratification. In many community ED's, risk assessment is done by the emergency physician. I'm lucky where I work, because we have a 24/7 psychiatric ED, which consults on suicidal patients in the "medical ED". In the end, assessment is primarily based on physician judgment, because there's no great clinical decision tool, rules, or scores to assess risk. Rob has created his own mnemonic to help you ask the right questions in assessing a suicidal patient. This is a sneak peek into a larger article that [+]
Hot off the press: MediBabble app
Ever since my post about the top medical apps, I have been inundated with people asking me to review their apps. One has stood out. Medibabble is a real-time medical translation app and is now available for FREE. It was created by two innovative UCSF medical school graduates, Dr. Alex Blau and Dr. Brad Cohn. This app contains an extensive preset list of history questions and physical exam commands. When you click on a sentence, the app will translate and speak the sentence in one of 5 languages (Spanish, Cantonese, Mandarin, Russian, and Haitian Creole). [+]
Trick of the Trade: Serial lactate measurements in sepsis?
Does your Emergency Department have computerized spectrophotometric catheters to measure continuous central venous oxygen saturation (ScvO2) in early goal directed therapy (EGDT) for severe sepsis? That’s what was used in the original Rivers’ EGDT study. I’ve never even seen one before. [+]
EMRAP Education Podcast: Educational Resources in EM
Dr. Rob Rogers has posted his 21st podcast on EMRAP Educator’s Edition. The topic is “Educational Resources in Emergency Medicine”. Listen to why you need to know about these resources: [+]
Director of Growth, Strategic Alliance [+]
Trick of the Trade: Conveying risk for postexposure prophylaxis
A health care worker hurried in to the ED after being poked with a needle. ‘It was an old 18G needle with dried blood’, she said. Her puncture had drawn blood. You discussed the very low risk of contacting HIV and the side effects of postexposure prophylaxis (PEP). She asked, ‘What does very low risk mean?’ Is there another way to covery risk for patients? [+]
Didactic videos for rotating residents the ED
Many academic Emergency Departments are staffed by non-EM residents. Dr. Amer Aldeen and his super-star team from Northwestern created NURRC Modules (Northwestern University Rotating Resident Curriculum). These modules allow the off-service residents, who all have different schedules, to learn key EM-based topics at their own leisure and convenience. The positive effect of the curriculum on the off-service residents’ medical knowledge was recently published in Academic Emergency Medicine [+]
Article review: How competent do trainees feel?
It is 2 a.m. You, the resident, have just spoken to your staff/attending, who told you to do a task. You have seen one, but don’t feel comfortable doing one independently. Will you tell your staff/attending about how you feel? What if the patient did poorly after that? This study examines the perception of EM trainees of their competence and adverse events and how they feel about reporting them. [+]