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. [+]
Article review: SAEM Tests
This is is a great look back at how SAEM Tests were developed and now used by EM clerkships across the country. Because EM does not have a National Board of Medical Examiners shelf exam, a tremendous effort was made by the authors to create a set of validated questions for clerkship directors to use. Specifically point serial correlation coefficients (range -1 to +1) were calculated for each question. A high coefficient means a high correlation between the performance on the individual test question and the performance on the overall test. After rewriting 25% of the test questions because of [+]
Paucis Verbis card: NIH Stroke Scale
Patients present with acute strokes to the Emergency Department. Time is of the essence to obtain a rapid neurologic exam, draw labs, get CT imaging, and consulting a neurologist especially if the patient presents within 3 hours of onset. To help the neurologist determine whether the patient should get thrombolytics, calculating a NIH Stroke Scale score is useful.w In this installment of the Paucis Verbis (In a Few Words) e-card series, here is the NIHSS scoresheet. Score 0 No stroke Score 1-4 Minor stroke Score 5-15 Moderate stroke Score 16-20 Moderate-severe stroke Score 21+ Severe stroke PV Card: NIH Stroke [+]
Hot off the press: Free EM Practice articles
Thanks to EB Medicine, “Emergency Medicine Practice” articles from 2007 and earlier are now free! This series is a well-written and practical evidence-based review resource for EM physicians. It’s a great place to start reading about bread-and-butter EM content, especially for medical students and junior residents. There haven’t been too much change in the past 3 years on many of the topics. [+]