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, [+]
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 [+]