Paucis Verbis card: Septic Arthritis
In the workup of monoarticular arthritis, the question that emergency physicians constantly struggle over is whether the patient has a nongonococcal septic arthritis. This joint infection alarmingly damages and erodes cartilage within only a few days. This installment of the Paucis Verbis (In a Few Words) e-card series reviews the JAMA Rational Clinical Examination article which asks "Does this patient have septic arthritis?" Pooled sensitivities and likelihood ratios were calculated. These statistics are always helpful when trying to figure out the patients probability of having a septic joint. I was surprised to learn that only about 50% of patients with [+]
Trick of the Trade: Finding the femoral vein by V-technique
I rarely access the femoral vein for central venous catheterization… except in medical or trauma resuscitations. Oftentimes in these resuscitations, there are too many people near the IJ or subclavian vein site. People are intubating, performing CPR, trying to get peripheral vein access, etc. [+]
Article Review: Conceptual Model on Learner Reflection
Reflective journals and electronic portfolios are becoming increasingly popular within undergraduate and graduate medical education. I’m starting to be a believer in this learning approach, which teaches learners about professional development and life-long learning principles. Academic Medicine just published a great qualitative paper proposing a conceptual model for reflection. [+]
SAEM 2010 (June 2-6, 2010)
The Society of Academic Emergency Medicine’s (SAEM) annual meeting starts this week. Instead of my regular posts, I thought I’d try using the Twitter widget to post real-time, first-hand accounts and photos from the conference. SAEM is a very dynamic and productive conference, where academicians in Emergency Medicine meet to pow-wow about the future of our specialty. [+]
PV Card: Dermatomal and Myotomal Maps
There are some things in life which I just can't memorize and dermatomal/myotomal maps are one of them. Weird cases of peripheral neurologic symptoms have presented to the ED in the setting of trauma and no trauma. So purely for selfish reasons, I'm making my own map to have on file. This installment of the Paucis Verbis (In a Few Words) e-card series reviews Sensory and Motor Function Testing by Levels. PV Card: Dermatomal and Myotomal Maps Go to ALiEM (PV) Cards for more resources.
Trick of the trade: Endotracheal tube lubrication
Does your endotracheal tube get caught up on a swollen or floppy epiglottis during insertion? Trick of the Trade: Endotracheal tube lubrication Occasionally the endotracheal tube may become “caught up” along the epiglottis. Because it is difficult to predict when this may happen, pre-lubricate the endotracheal tube cuff and tip with a thin layer of water-soluble lubricant, such as K-Y jelly. This lubricant can also minimize the degree of surface trauma to the trachea and tracheal rings as the tube passes the vocal cords.
Paucis Verbis card: Ottawa knee, ankle, and foot rules
Often times, I get called to triage to help decide whether a patient should be sent to Radiology for an initial x-ray after injuring their knee, ankle, and/or foot. After teaching one of the nurses about the Ottawa rules, she taped a list of these rules on the triage wall. This installment of the Paucis Verbis (In a Few Words) e-card series reviews Ottawa Knee, Ankle, and Foot Rules. [+]
Creating and delivering the stellar lecture
I recently re-read a book “Made to Stick” by Chip Heath and Dan Heath which discusses why some ideas stick and others are completely forgettable. The concepts discussed have helped me design lectures. Here’s something that I have incorporated into my talks: Memorable ideas share common attributes, which can be summarized by the acronym SUCCESs. [+]
Trick of the trade: Percuss the spine in low back pain
Many patients present to the Emergency Department for low back pain. Determining whether these patients have a red-flag diagnosis can be difficult. Red flag diagnoses include: Fracture Cauda equina syndrome/ spinal cord compression Spinal infection Vertebral malignancy Almost all patients presenting with back pain, whether it be a muscle spasm or a spinal epidural abscess, will have back tenderness to some extent. So, how can you better differentiate benign from dangerous etiologies? [+]
Poll: How do you recover from a night shift?
There are so many amazing things that we get to see and do as emergency physicians. We see sick, undifferentiated patients who need our help acutely. We have cool toys, such as ultrasounds. We get to do great procedures. We work on a shift-based schedule. We work in team-based fashion with fun nurses, technicians, and staff. However, one major down side is that almost all of us work some night shifts. [+]