Paucis Verbis card: Knee exam
How accurate is the clinical knee exam? JAMA published a meta-analysis trying to answer this question. Although they include patients with acute and chronic knee pain, it's a good general review of the knee anatomy, historical clues, and exam elements. In the ED, the knee exam is challenging because we see very acute injuries where knee pain and swelling often preclude an accurate exam. For patients with an equivocal exam, be sure to refer for orthopedic follow-up. A repeat exam should be performed once the pain and swelling subside. This installment of the Paucis Verbis (In a Few Words) e-card [+]
Tricks of the trade: Chemical sedation options
You walk into a room where a patient is screaming and thrashing about in his/her gurney from some stimulant abuse. PCP, cocaine, methamphetamine… or all of the above. When the number of people (police officers, security guards, nurses) is greater than the patient’s pupil size, you KNOW that you’ll need some chemical sedation. What intramuscular sedation regimen do you use? [+]
Work in progress: Poster on blogging
I need your help with a project! My poster on blogging was accepted to the annual UCSF Academy of Medical Educator’s Education Day. Feelings of joy and validation were quickly followed by terror and inadequacy. In order to get my poster costs reimbursed, I have to get feedback from my co-authors and incorporate that feedback into the poster. As you can see from the poster title on top, I have no co-authors! Since you are all my virtual co-authors, I thought I’d solicit for comments and suggestions. [+]
Article review: ED crowding and education
"The effect of ED crowding on education" My heart almost stopped when I read this article title in Amer J of Emerg Med. This was the premise of my recently completed study - using a prospective, time-motion methodology. I'm in the process of writing the manuscript. Did I get scooped by my friends at U Penn?Whew. Fortunately, no. Different methodology.This study was a cross-sectional study looking at learner assessment of education, using a validated tool called the ER (Emergency Rotation) Score. The results are interesting. The problem We know that ED crowding negatively impacts clinical care. How does it impact [+]
Paucis Verbis card: Hyperkalemia management
Hyperkalemia is a common presentation in the Emergency Department, especially in the setting of acute renal failure. In one shift, I had 4 patients with hyperkalemia! All had from some form of renal failure. This installment of the Paucis Verbis (In a Few Words) e-card series reviews the treatment options for hyperkalemia. PV Card: Hyperkalemia Adapted from [1] Go to ALiEM (PV) Cards for more resources. Reference Weisberg L. Management of severe hyperkalemia. Crit Care Med. 2008;36(12):3246-3251. [PubMed]
Trick of the Trade: Minimizing abscess odor
Building on my theme of combating odors in the Emergency Department (see Toxic Sock Syndrome), foul-smelling pus from large abscesses has got to be one of the most nauseating smells in the ED for me. Trick of the Trade Use a Yankauer to suction up pus [+]
EM blogger roll call
How do I keep up with the information from the myriad of Emergency Medicine websites out there? Blogs, Twitter, Journals, oh my. Thanks to LifeInTheFastLane, you can check out all the current EM bloggers out there with their Twitter name and RSS feed links! I had no idea there were so many. I can appreciate how much time and effort it took to compile this list. Fantastic job, guys. [+]
Paucis Verbis card: Aneurysmal subarachnoid hemorrhage
Atraumatic subarachnoid bleeds are most commonly caused by ruptured intracranial aneurysms. This installment of the Paucis Verbis (In a Few Words) e-card series reviews the current management, knowledge, and challenges in aneurysmal subarachnoid hemorrhage (SAH). PV Card: Subarachnoid Hemorrhage Adapted from [1] Go to ALiEM (PV) Cards for more resources. Reference Edlow J, Malek A, Ogilvy C. Aneurysmal subarachnoid hemorrhage: update for emergency physicians. J Emerg Med. 2008;34(3):237-251. [PubMed]
Trick of the trade: Irrigation scalp wound photos
I mentioned from an earlier post about building a "head basin" for collecting irrigation fluid prior to wound closure. This basin prevents a deluge of fluid from soaking the gurney sheets and patient. I finally managed to capture this trick in action, while a student was irrigating an eyebrow laceration. Pearl When cutting out a semi-circular or rectangular hole in the basin, be sure that there remains a 2-4 inch lip at the bottom to ensure that fluid can collect in the basin.
Great teaching video: Cell and flare
Using the slit lamp can be a challenge to learn, especially if you haven’t seen pathology before. In checking for anterior uveitis (i.e. iritis), you need to look for “cell and flare”. In theory, you know that you are looking for inflammatory cells and “flare”, which resembles a light beam being filtered through smoke. [+]