Article review: Mentoring in EM
This article in the Canadian Journal of Emergency Medical Care reviews the EM literature on mentoring. The authors specifically do a great job summarizing practical tips. What is a mentor? It is a person who supports and guides a junior colleague (junior faculty member, residents, or medical student) in his/her professional development. [+]
Paucis Verbis card: Vasopressors and Inotropes for Shock
The treatment of shock should focus on correcting the underlying pathophysiology. With persistent hemodynamic instability, a vasopressor and/or inotrope should be selected. Reviewing receptor physiology can help you select the best-fit agent for the patient's clinical condition. There is an especially useful table on medication selection in the reviewed 2008 EM Clinics of North America article. This installment of the Paucis Verbis (In a Few Words) e-card series reviews Vasopressors and Inotropes for the Treatment of Shock. PV Card: Vasopressors and Inotropes in Shock Adapted from [1] Go to ALiEM (PV) Cards for more resources. Edit 3/28/14: Dopamine removed as [+]
Trick of the Trade: Radial Gutter Splint
How do you splint 2nd or 3rd metacarpal fractures? A short arm volar splint is usually applied, because a fracture should be immobilized one joint distal and proximal to the injury. This splint, however, unnecessarily immobilizes the 4th and 5th fingers. It makes gripping things with your hand difficult. [+]
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Paucis Verbis card: Skipping the CT prior to LP for meningitis
With increasing awareness of CT’s irradiation risk, I thought I would review a classic 2001 article from the New England Journal of Medicine. Head CT’s previously were commonly performed prior to all lumbar punctures (LP) to rule-out meningitis. When can you safely go straight to an LP without imaging? Caveat: This review only applies to those patients in whom you suspect meningitis. This does not apply to those being worked up for subarachnoid hemorrhage. [+]
Trick of the Trade: A "handy" ruler
How long is this neck laceration? In the Emergency Department, it is important to be able to accurately estimate the length of wounds, abscesses, and cellulitis. Additionally, billing for wound closure is directly related to the length of the laceration. [+]
Paucis Verbis card: Early goal directed therapy
One of the landmark studies in sepsis was conducted by Dr. Emanuel Rivers (Henry Ford) and published in the New England Journal of Medicine in 2001. By managing patients with severe sepsis and septic shock with an "early goal directed therapy" approach, there was an absolute risk reduction of 16%. Furthermore, the number needed to treat to save a life was 6 patients! This installment of the Paucis Verbis (In a Few Words) e-card series reviews Early Goal Directed Therapy algorithm. The layout is borrowed from a Cleveland Clinic Foundation (CCF) flowchart. Adapted from [1] Go to ALiEM (PV) Cards [+]
Trick of the Trade: Retracting Swollen Eyelids
Eyelids can become edematous from blunt trauma and local inflammation, making it difficult to visualize the orbit. How do you retract the eyelids, if you don't have the fancy ophthalmology eyelid retractors? Trick of the Trade Use a Q-tip I thought of this idea when I was rolling up a projector screen in a conference room. Why can't we use this rotational concept on the upper eyelid to retract it? Rest the Q-tip on the surface of the upper eyelid and slowly rotate the Q-tip to "roll" the eyelid out of the way. Below are a series of photos of [+]
Amazing video: Awake endotracheal intubation
Videos are priceless when trying to teach procedures. This amazing teaching video by Dr. Michael Bailin at Mass General demonstrates a novel way of anesthetizing the airway during an awake intubation. Inject 3 cc of lidocaine using a small butterfly needle through the cricothyroid membrane. This causes coughing, which spreads the lidocaine throughout the upper airway. Inject 5 cc of atomized lidocaine through the fiberoptic scope port to anesthetize the posterior oropharynx and vocal cords. Slide the endotracheal tube over the fiberoptic scope. [+]
Trick of the trade: Eye irrigation setup
Morgan lens are placed to irrigate eyes splashed with foreign substances. Whenever I place them, images of horror and torture movies arise. Especially for patients who aren't used to having something touch their eyes like contact lens, the Morgan lens gives them the heeby-jeebies. For the past several years, I've stopped using Morgan lens and have started using something that all Emergency Departments have -- nasal cannulas for oxygen administration. They are perfect for high-volume eye irrigation. Instead of attaching the nasal cannula to an oxygen port, attach it to the end of IV tubing, which in turn is attached [+]
Joining the Research Blogging community
Yesterday, I posted a review of an Academic Medicine education article on how to prepare medical students for their clinical clerkships, based on the Kolb learning cycle model. My blog post is now also linked and searchable from the Research Blogging network at http://researchblogging.org. Thanks to Life in the Fast Lane, who told me about the site. [+]