Paucis Verbis: Management of Accidental Hypothermia
With all of the amazing, sunny weather here in California, I feel (briefly) terrible for all those braving the snowpocalyptic conditions across the United States. So, in honor of all those bundled up and shivering, I wanted to review the management of accidental hypothermia. Tip: Avoid jostling the hypothermic patient too much because of myocardial irritability. Don't send your patient into an arrhythmia. PV Card: Management of Accidental Hypothermia Go to ALiEM (PV) Cards for more resources.
School Sucks: Building a new culture of teaching and learning
In his talk (subtitled “School Sucks”), Northwestern University Physics Professor Dr. Tae describes how he would improve math and science education. While this is directed at college studies, some of the concepts are applicable to teaching Emergency Medicine. He shares a lot of great insight, but I wanted to focus on one concept in particular: The secret to learning = “Work your ass off until you figure it out.” [+]
Trick of the Trade: Getting an EKG on Chewbacca
Patients with a hairy chest may require little patches of hair to be shaved when applying EKG leads. This allows the leads to stick firmly to the chest. Loose leads will result in either an artifactual signal or no signal at all on the EKG machine. How can you obtain an EKG without shaving little patches on the patient’s chest? [+]
Paucis Verbis card: The Shoulder Exam
How many times have you had to look up the shoulder exam maneuvers for patients with acute shoulder pain? I don't know why I just can't seem to remember these. This Paucis Verbis card is a quick reference card to remind you of the most common techniques. Thanks to Jenny for the idea. PV Card: Shoulder Exam Go to ALiEM (PV) Cards for more resources.
Article Review: Online curriculum for non-EM residents in the ED
In many academic Emergency Departments, there are “off-service” or non-EM residents rotating in the department. They are sometimes invited to the EM residency conference series for the month. Often times though, they have too many departmental didactic events and obligations of their own that they don’t have time to attend formal EM didactics. [+]
Paucis Verbis card: Generalized Convulsive Status Epilepticus
How do you manage patients who present in status epilepticus, knowing that "time is CNS function"? The longer patients remain seizing, the greater their morbidity and mortality. Did you know that one study showed that 48% of their patients who presented in generalized convulsive status epilepticus (GCSE) had subtle persistent GCSE on EEG, despite no clinical evidence of overt seizure activity? That's scary. Do you send off a serum tricyclic toxicology screen for all your patients with GCSE? Because of the prevalence of TCA overdoses locally, our Neurology consultants definitely order it. We are picking up a surprising number of [+]
VIPER video: How to give effective feedback
A few years ago, Dr. Esther Choo and I created a fun 15-minute instructional video on called Giving Effective Feedback: Beyond “Great Job”. We had a blast recording sample feedback scenarios with our faculty and medical students. For every 1 minute of published footage, there were at least 9 minutes of bloopers and laughter! We definitely should keep our day job. [+]
Tricks of the Trade: Nursemaid elbow reduction
We’ve all seen it before while working in the ED. A parent brings in their child because they pulled on their arm, and now the child is not using it. Parents are thoroughly convinced that the child’s arm is either broken or dislocated. We all recognize this as radial head subluxation or “nursemaid’s elbow” and immediately attempt to reduce it. The provider takes the injured arm, supinates at the wrist and flexes at the elbow. Does the child scream? What if nothing happens? Is there an alternative technique to reducing a nursemaid elbow? [+]
Article review: Academic professional bankruptcy
In academia, faculty are expected to do it all– clinical care, bedside teaching, formal didactics, scholarly work, and administrative projects. Asking for protected time, or release time from clinical work, from your department chair is often a difficult negotiation process, especially for junior faculty. Fresh out of residency and fellowship training, junior faculty are just excited to get started as an academic faculty member. A downpour of exciting opportunities descends upon you, and you just can’t say no to them! A year later passes, and you realize that you are overwhelmed. [+]
Paucis Verbis card: Workup for first-time seizure
How do you workup adult patients who present with a new-onset seizure and now neurologically back to normal? There unfortunately is very little recent literature about the best workup approach. In 1994, the American College of Emergency Physicians (ACEP) published a Clinical Policy based on expert consensus. The EM Clinics of North America series also just published a review on the topic. The bottom-line is that there are two types of workup approaches. For the uncomplicated cases (age less than 40 years, afebrile, no comorbidities, no neurologic deficits), the workup is fairly minimal, which includes: Glucose and electrolytes Urine pregnancy test, [+]