Need your help! Favorite medical apps
So, I volunteered to give a talk for the UCSF Office of Graduate Medical Education WAAAAY back in early 2010 on “There’s an App for That: Key Smart Phone Applications for Surviving Residency”. Somehow the lecture date has snuck up on me and it’s next Tuesday! I thought it was a small gathering, but it turns out it’s not. Plus, I keep getting school-wide emails reminding all the residents and fellows to attending! [+]
Trick of the Trade: Reducing post-LP headache risk
We often do lumbar puncture in the ED. Patients get warned about the potential of a post LP headache. What is the prevalence of a post-LP headache? The literature reports 15% of ED patients have a post LP headache. [+]
Hot off the press: A summary of EM content in social media
The ever-creative and ambitious masterminds at Life in the Fast Lane has just launched a new feature called LITFL Review. This weekly review will highlight all-things EM in the social media world. Do they ever sleep over there in Australia?! Do they somehow have 25 hours in their day? [+]
Paucis Verbis card: Suture Materials
Suturing is a common procedure performed in the ED, but we too often forget about the nuances of different suture materials. We get set in our practice patterns. This changed when our ED got the fast-absorbing gut suture for surface wounds, especially for pediatric patients. This makes a return visit for suture removal unnecessary because they quickly become absorbed over time. Increasingly, I have observed plastics surgeons using these for surface wound closure of the face and hands. Has anyone else used absorbable sutures on the skin for wound closure? With this new suture material in my armamentarium, I thought [+]
Tricks of the Trade: Finding the wandering contact lens
Contact lens wearers are familiar with the phenomenon of the wandering lens. What should you do if you can’t visualize the contact lens of a patient, who presents with a “lost contact lens” in the eye? You have the patient look in all directions and you evert the eyelid, but still no contact lens can be found. The patient swears that it’s there because of the painful foreign-body sensation. [+]
Diagnoses that sound alike
Emergency Medicine is as much about taking care of undifferentiated patients as it is about naming specific signs, symptoms and diagnoses. After 10 years of medical training I’ve noticed that there are a few diseases that require us to stop and think a bit. In particular I’m thinking about conditions that share these features: They sound-alike, look-alike, or share words or roots of words They affect a specific organ or part of the body They have very different etiologies, implications, prognosis and treatment The two sets of diagnoses that I encounter most frequently with this problem are Mesenteric Ischemia (or [+]
Paucis Verbis card: Subarachnoid hemorrhage high-risk characteristics
In Wednesday's post about the Colorado Compendium, Graham mentioned a new 2010 BMJ article on the high-risk signs suggestive of subarachnoid hemorrhage by the gurus in clinical prediction rules in Canada. We excessively work-up patients for a subarachnoid hemorrhage with a nonspecific headache and no neurologic deficitis. This is because it's difficult to predict who is high, medium, and low risk for such a bleed. So we throw a wider net so that we don't miss such a devastating diagnosis. This usually means a CT and LP for many patients with a headache. In this 5-year multicenter study, the investigators [+]
Paucis Verbis card: Cervical spine imaging rules
There is constant debate on whether to image the cervical spine of blunt trauma patients. Fortunately, there are two clinical decision tools available to help you with your evidence-based practice. The NEXUS and Canadian C-spine Rules (CCR) are both validated studies which both quote a high sensitivity (over 99%) in detecting clinically significant cervical spine fractures. Both studies primarily used plain films in evaluating their patients. Sensitivity (%) Specificity (%) NEXUS 99.6 12.6 CCR 99.4 45.1 NEXUS National Emergency X-radiography Utilization Study A patient’s neck can be clinically cleared safely without radiographic imaging if all five low-risk conditions are [+]
Trick of the Trade: Self-Reflection
After a shift, we often review the day’s case with our learners. We sometimes ask them to self-reflect. I often used Demian’s ‘Plus/Delta’ approach and ask ‘What did you like /what would you change?’ This approach works well mostly. But, when the answer is ‘I don’t think I would change anything’, it is hard to target teaching and feedback to the learner’s need. [+]
Article review: Consensus methodologies in qualitative research
What types of methodologies are used to develop a consensus statement? I’m in the midst of helping to write a consensus statement manuscript in education and ran into this great review article. It’s from the British Medical Journal in 1995. Basically, there are 2 general types of methodologies: Delphi Process Nominal Group Technique [+]