Paucis Verbis card: Dysphagia
Dyphagia is a disorder of swallowing. It actually occurs in up to 10% of adults older than 50 years old. How can you determine the most likely causes for dysphagia? The secret is to obtain a thorough history and using the algorithm below, which I find really helpful from a review article in American Family Physician. How do you read the figure? Determine first if patient has oropharyngeal vs esophageal dysphagia. Determine if mechanical (problem is solid foods only) vs neuromuscular (problem with liquids and solids)is more likely. Tip: Medications can cause dysphagia from esophageal mucosal injury or reduced lower [+]
Hot off the press: Medical Student Educator’s Handbook
It’s finally here! The second edition to the Medical Student Educator’s Handbook is finished. Here’s the info from the CDEM website: [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief [+]
Trick of the Trade: Laryngospasm notch maneuver
What is the incidence of laryngospasm in pediatric patients receiving ketamine for procedural sedation in the ED? Answer = 0.3% A child with laryngospasm can be a scary thing to manage. There’s no way to predict whether a child is going to get it. You can try the usual maneuvers including a jaw-thrust, positive pressure ventilation to try to open the vocal cords, and suctioning. If these don’t work, you might consider giving the patient a paralytic, such as succinylcholine, and performing an endotracheal intubation for worsening hypoxia. Before that, what non-invasive maneuver can you try first? [+]
Pros and Cons of Social Media Use in Medicine
The American Medical Association (AMA) just released a policy on Social Media and Medical Professionalism. It focuses more on the negative aspects of social media, and much can be averted by just using common sense: [+]
Trick of the Trade: Hemostasis of bleeding finger laceration using a glove
Lacerations of the finger can bleed quite profusely because of digital vascularity. This obscures the provider’s ability to perform a careful exam and can make suturing quite difficult. Simple direct pressure over the laceration often controls the bleeding. What if this doesn’t work? [+]
Article review: Coaching in emergency medicine
After a chaotic shift, you and your learner sit down to complete the daily evaluation card. There are no significant issues with the learner. Is there anything else to write except ‘great shift’ or ‘read more’? Can we learn from excellent motivators such as sports coaches? This article by LeBlanc and Sherbino outlines coaching as a teaching technique in the ED. [+]
Paucis Verbis: Identifying toxidromes by vital signs
A middle-age woman presents to the Emergency Department with altered mental status after having ingested a drug. Is it an opioid? Is it an antihistamine? The key is to pay close attention to the vital signs. They are often the clue to the mystery. I found this great table from EM Clinics of North America by Dr. Timothy Erickson from 2007. I can't imagine how long it took for him to create all these mnemonics. I'll never remember these mnemonics, but they're fun to read nonetheless. PV Card: Toxidromes by Vital Signs Go to ALiEM (PV) Cards for more resources.
New 2010 ACLS guidelines from the AHA, ERC, and ILCOR
Last month the AHA, ERC, and ILCOR released the 2010 Resuscitation Guidelines. They build on the 2005 and previous guidelines and continue the trend towards more, higher quality, uninterrupted CPR. The complete summary and recommendations are published in Circulation and are available for free. Here is my summary for you! [+]
Trick of the Trade: Toe paronychia splinting
Ingrown toenails, or paronychias, are usually exquisitely painful and a bit gnarly when they present to you in the Emergency Department. Dr. Stella Yiu described toenail splinting techniques using steristrips or dental floss. The purpose of splinting is to prevent the toenail from growing back into the lateral nail fold. This assumes a relatively mild-to-moderate case. Often simple elevation of the nail out of the lateral nail fold (under digital block anesthesia) is all that is needed to treat a paronychia. Pus is often released with this maneuver. What do you do for more severe cases when you have to [+]
Article review: Pitfalls in writing test questions
Which is the best answer? A. Yes B. No C. Maybe D. 2 of the 3 above E. None of the above Wait, what?! What a terribly written test question! [+]
Director of Growth, Strategic Alliance [+]