Paucis Verbis card: Procedural sedation and analgesia
From time to time, our patients need moderated and deep sedation in order to tolerate painful procedures such as joint reductions or incision and drainage procedures. There are many medications available to us including some newer ones such as Ketofol and Dexmedetomidine. This week's Paucis Verbis is a reference card to remind us of the importance of Airway Assessment and help us calculate the medication doses. If you want to learn more about these medications and some strategies for different types of patients and procedures I recommend the EMCRIT Podcast PSA Lectures 1 and 2. PV Card: Procedural Sedation and Analgesia Adapted [+]
Trick of the Trade: Prescribing opiates
As emergency physicians, we are experts in pain control. We frequently write opiate prescriptions for patients being discharged home. Unfortunately, an occasional patient tries to forge my prescription. At times, I get a call from pharmacy for prescriptions that were suspiciously written. For instance several years ago, I had someone try to forge 100 tablets of “Mophine”. [+]
YouTube increases limit to 15 minutes
I have slowly been building my video database of instructional media on YouTube under my YouTube Channel called “ITIMEinEM”. It stands for Innovative Technologies In Medical Education in Emergency Medicine. All of the videos have been used in this blog. [+]
Paucis Verbis card: Strep pharyngitis
Have you heard of the Modified Centor Score for strep pharyngitis? Interestingly, it has been validated in adults and children. The methodology builds on the traditional Centor Score by incorporating the patient’s age, because this disease is more prevalent in kids than adults. In fact, you actually lose a scoring point if you are older than 44 years old. [+]
Brain Slides: My new favorite blog
I just encountered a new blog called Brain Slides: Presentation Design for Educators, written by Nathan Cashion. This blog eloquently teaches how Powerpoint should and, more importantly, shouldn’t be used. [+]
Director of Growth, Strategic Alliance [+]
Trick of the Trade: Foley balloon be gone!
An urethral Foley catheter can sometimes become retained in the bladder, because of its balloon being unable to deflate. A malfunctioning inflation valve or obstructed channel along the length of the catheter is the cause. How can you deflate the balloon so that the Foley catheter can be removed? [+]
Article Review: Premature diagnostic closure
You are taking care of a patient, who frequently presents to the ED for polysubstance use. You are pretty sure his altered mental status is from polysubstance use again. He was found in his home next to drug paraphernalia. He intermittently becomes severely agitated, and so you give him sedatives. He has a low-grade fever, but you attribute that to his psychomotor agitation and likely stimulant use. Because he remains confused and lethargic after 8 hours, you admit him to an inpatient team to await further metabolism of his recreational drugs and your sedation medications. The next day, you learn [+]
Paucis Verbis card: Urine Toxicology Screen
In the Emergency Department, we often order urine toxicology screens for patients with altered mental status without an obvious cause. I find that patients are often rather forthcoming about their drug use, if they are alert enough to talk. In those cases, ordering a urine toxicology screen is unnecessary. When you do order a tox screen, however, how do you interpret the information? While the result is a binary answer (positive vs negative), there are some nuances to interpretation. For instance, how long does a patient with urine toxicology remain positive for the drugs? Are there any medications that can [+]
Trick of the Trade: A tongue blade is as mighty as an xray
Patients often present to the Emergency Department for mandibular blunt trauma. Usually these patients have soft tissue swelling at the point of impact. In mandibular body fractures, the fracture line often extends to the alevolar ridge. This may cause a gap between a pair of lower teeth. In patients with jaw pain, mild swelling, and normal dentition, is there a way to avoid imaging these patients to rule-out a mandible fracture? [+]
Paucis Verbis card: Rapid Sequence Intubation
The key to success in performing procedures is preparation. This is especially true for endotracheal intubations in the Emergency Department where things are chaotic. Strategic planning and anticipation of obstacles during rapid sequence intubation (RSI) are key principles to avoiding complications. PV Card: Rapid Sequence Intubation Go to ALiEM (PV) Cards for more resources.