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 [+]
Trick of the Trade: Ultrasound-guided supraclavicular central line
Emergency physicians are procedural experts in central venous access. The subclavian vein is the best site for such access, because it has been shown to have the lowest rate of iatrogenic infections and deep venous clots Bedside ultrasonography has really revolutionized how we obtain vascular access over the past 10 years. Identifying the subclavian vein using ultrasonography, however, is still technically challenging. The vein is located just posterior to the clavicle, which often gets in the way of the linear transducer. [+]
Paucis Verbis: Sgarbossa’s Criteria with LBBB
It is difficult to determine if a patient with a left bundle branch block (LBBB) has an acute myocardial infarction (AMI) because ST segments are "appropriately discordant" with the terminal portion of the QRS. That means if the QRS complex is negative (or downgoing), the ST segment normally will be positive (or elevated). Similarly if the QRS complex is positive (or upgoing), the ST segment will be negative (or depressed). PV Card: Sgarbossa's Criteria In 1996, Sgarbossa et al looked through the GUSTO-1 trial patients with LBBB and AMI. They derived 3 criteria which may help diagnose the "hidden" AMI. [+]
Residency interview season: Pitfalls
I often get asked by my advisees: “In my residency interview, what should I talk about or do to make myself more competitive?” To help you demystify the interview process, I wanted to share with you some insights. Overall, the interview day itself helps the program put a person and personality with your online ERAS application. Similarly, you quickly get a sense of the program’s personality. In EM, the residency interview day is generally pretty laid back. Not too many crazy questions. Programs just want to get to know you. Both you and the program should be asking each other– Is [+]
Trick of the Trade: Legg Maneuever for shoulder dislocation
There are many ways to relocate a shoulder dislocation. Most of these ways require procedural sedation. What if the risks of procedural sedation outweigh the risks? What alternative maneuver can you try, which only requires parenteral pain medications +/- an intra-articular lidocaine? [+]
New kid on the block: Univ of Washington EM residency
How awesome would it be if there were EM residency programs at the University of Washington and UCSF-SF General Hospital?! This has been the question for decades. In 2006, I had the pleasure of seeing the UCSF-SFGH program become a reality. And now it’s the University of Washington’s turn. It is close to becoming a reality. It is really one of the last powerhouse institutions which does not have an EM residency program. The Univ of Washington EM residency’s Program Director is helmed by my superstar friend, Dr. Fiona Gallahue, and will be a 4-year program. The ACGME (accrediting organization) [+]
Article review: Inaccuracy in the SLOR
Residency interview season is quickly approaching! Unique to the field of EM, letters of recommendations from EM faculty are written on a standardized form. The Standardized Letter of Recommendation (SLOR), downloadable from the CORD website, documents information about the student’s performance in the EM clerkship, qualifications, and global assessment. At the end, the letter writer can provide free-text written comments. [+]
Paucis Verbis card: Algorithm for suspected pertussis in pediatrics
To treat for pertussis or not? In the setting of the current pertussis epidemic in California, each kid with a cough sparks constant debate about whether to treat with azithromycin or not. Finally, thanks to my friends Dr. Andi Marmor and Dr. Shon Agarwal Jain (UCSF Pediatrics faculty), there's a great algorithm to help you answer the question. I have found this algorithm extremely helpful. You basically start by risk-stratifying by age and pertussis immunization status. For instance, if the patient is 6 months of age AND unimmunized), then follow the algorithm listed as "High Risk for Pertussis". PV Card: [+]