Article review: Preparing for clinical clerkships during medical school
Do you remember the sheer terror you felt, when you first started your medical school clinical rotations? Your first two years were probably spent in classrooms and small-group labs discussing anatomy, pharmacology, pathology, etc. Then BAM! You are thrown into the deep end of the pool. You are now on a clinical team of medical professionals taking care of actual patients! [+]
Paucis Verbis card: ABG interpretation
I have yet to find a better arterial blood gas interpretation review article than the 1991 Western Journal of Medicine summary by Dr. Rick Haber. This installment of the Paucis Verbis (In a Few Words) e-card series reviews ABG Interpretation. The recent addition of an ABG machine in our ED has made a tremendous difference in our ability to care for undifferentiated patients. This is a refresher in making heads and tails of mixed acid-base disorders. Adapted from [1] Go to ALiEM (PV) Cards for more resources. Reference Haber R. A practical approach to acid-base disorders. West J Med. 1991;155(2):146-151. [PubMed]
What do you do with old posters?
In academia, it is common practice to make posters of your abstracts for national conferences. Once you are done presenting, what DO people do with the posters? I have several posters rolled up in my garage collected over the years. If the answer is nothing, why can’t we find a more creative way to display static (or even video) content during abstract sessions? Perhaps use a large LCD screen instead of posters taped to a backboard? [+]
Tricks of the trade: Anesthetizing the nasopharyngeal tract
Nasogastric tube placement is one of the most uncomfortable procedures in the Emergency Department. Why can’t we find a painless way to do this? Now that I am doing more fiberoptic nasopharyngoscopes, this issue is coming up more and more frequently. I’ve been using NP scopes mainly to check for laryngeal edema in the setting of angioedema. These recent photos visualize a normal epiglottis and normal laryngeal anatomy, respectively. [+]
Great teaching video: Corneal FB removal
Patients often come into the ED for eye pain. One of my favorite procedures is removal of a small foreign body embedded in the cornea. There is a great instructional video on removing such foreign bodies and the use of a ophthalmic burr on removing rust rings. The video recommends using either a 30-gauge or 18-gauge needle. I prefer the less innocuous-looking 29-gauge insulin/TB needle. Can you imagine someone coming towards your eye with a large 18-gauge needle?! [+]
Article review: The future of EM
As I was perusing through a recent Academic Medicine journal, I came across this interesting perspective piece on Emergency Medicine, written by national leaders in our specialty. This article essentially states that how the nation addresses ED crowding will define the future of EM. Currently, Emergency Departments are at a breaking point where overwhelming demands are commonly placed on under-resourced practices. [+]
Paucis Verbis card: Angioedema
Recently, a patient presented with angioedema after starting taking an ACE-inhibitor. There was upper lip swelling, similar appearing to the case above. He also experience a hoarse voice. Before the advent of fiberoptic nasopharyngoscopy, it was assumed that there may be laryngeal edema. Fortunately, using technology, we were able to visualize a normal epiglottis and a grossly normal laryngeal anatomy. Should patient with angioedema be admitted? The 1999 study on admission guidelines, of course, should be weighed with physician judgment and the patient's social issues. The study was retrospective and the results should be weighed carefully. For me, generally I [+]
Trick of the trade: Ear foreign body extraction
A 6-year old boy has placed a hard bead in his ear and presents to the ED for care. How do you remove this foreign body as painlessly as possible? You can just barely see the edge of the bead by just looking at the external ear. By experience, you know that mini-Alligator clips and forceps will not be able to sufficiently grab the edges of the bead. Additionally it may push the bead in even further. [+]
Work in progress: How can you balance ED crowding and education?
I’m working on writing a CORD consensus article on the impact of ED crowding on education and innovations towards maintaining educational excellence. We posited 2 scenarios of ED crowding: Overwhelming numbers of active ED patients Many ED boarders who are awaiting inpatient beds and who are taking up rooms which normally would have been used to see new patients What approaches do you know of which improve the ED educational experience for learners? We have thus far categorized innovations into 3 areas: [+]
Article review: The next 10 years in medical education
“Medical Education in the United States and Canada in 1910” was a landmark article, published by Abraham Flexner (shown in photo) in 1910. It’s commonly referred to as the Flexner Report. It revolutionized medical education in its call for higher quality and standardization. In summary the report advocated for the improvement of medical education and medical schools in 4 areas: [+]