Trick of the trade: Spicing up your evidence-based lecture
Before I start creating a new talk, I ask myself 3 questions: Who will be in the audience? How can I make my talk more worthwhile to audience members, beyond their just reading the material/handout/articles on their own? Am I giving a talk before or after Dr. Amal Mattu? If so, just be resigned to being second-best. [+]
Paucis Verbis card: Ankle fractures
Ankle fractures are a common injury diagnosed in the Emergency Department. Being able to speak Ortho-ese (i.e. the language of orthopedists) is invaluable in consulting the orthopedist over the phone. One ankle fracture classification system that our orthopedists like to use is the Lauge-Hansen system. PV Card: Lauge-Hansen Classification of Ankle Fractures Go to ALiEM (PV) Cards for more resources.
iPhone uses in the Emergency Department
Occasionally, I get a rare – “Hey congrats on the article!” comment from residents or students. It’s usually in reference to my ACEP News column that comes out every 3 months on Tricks of the Trade. However, I got about 3 shout-outs in the past 2 days. How odd. Then I saw one of our office staff who was reading EM News. “Hey cool!” she said. Totally confused, I realized that I was quoted on the front page of this week’s publication about iPhone applications in EM. Many months ago, I had done a brief telephone interview with the writer. [+]
Trick of the Trade: My new penlight
On any given day in the ED, I use my super-bright penlight 2-5 times a day. It is amazing what things I’ve almost missed without a bright LED flashlight. Subtle HSV-2 labial ulcerations in a female patient with dysuria Additional scalp lacerations hidden in the hair Tonsillar exudates in a patient with strep pharyngitis Unequal pupillary responses in a brightly lit trauma room in a head-injured patient I wanted to revisit a prior post about the importance of changing your Tungsten penlight to a LED light. [+]
Paucis Verbis card: Urinary tract infection
In this installment of the Paucis Verbis (In a Few Words) e-card series, the topic is Urinary Tract Infection. UTIs are one of the most common infections that we treat in the Emergency Department. PV Card: Urinary Tract Infection Adapted from [1] Go to ALiEM (PV) Cards for more resources. Reference Norris D, Young J. Urinary tract infections: diagnosis and management in the emergency department. Emerg Med Clin North Am. 2008;26(2):413-30, ix. [PubMed]
Beware the hidden tibia plateau fracture
Find the fracture in this patient with blunt knee trauma. As a general rule, plain films are insensitive in ruling out orthopedic injuries. One particularly tricky area is the knee. This 2-view knee series above is normal. Did you know that the sensitivity of picking up knee fractures is as low as 79% with a 2-view series and 85% with a 4-view series? With the advent of CT imaging, more and more subtle fractures are being found. [+]
Trick of the trade: Minimizing post-LP headache
Have you ever performed a lumbar puncture (LP) in a patient, only to have them return the next day for new debilitating headaches? It’s worse when sitting up, and much improved when laying down. You hate adding more problems for the patient, put you are certain that s/he now has a post-LP headache. [+]
Article review: Glidescope success in difficult airway simulation
Since our department got a Glidescope, it has rapidly become a go-to difficult airway adjunct when intubating patients in the ED. Note: I have no financial ties to Glidescope. This education article Sim Healthcare is a head-to-head comparison between video laryngoscopy (VL) versus direct laryngoscopy (DL) in a difficult airway simulation model. In this prospective, convenience sample of EM attendings and residents who were all novice operators of VL, the subjects were asked intubate 3 types of mannequin scenarios using a Macintosh curve laryngoscope for DL and a Glidescope for VL. [+]
Paucis Verbis card: Pediatric blunt head injury
In this installment of the Paucis Verbis (In a Few Words) e-card series, the topic is Pediatric Blunt Head Trauma. This a particularly relevant topic given the recent press and discussions about CT irradiation and the cancer risk especially in pediatric patients. It's also relevant since Dr. Nate Kuppermann (UC Davis) just gave Grand Rounds at our UCSF-SFGH EM residency program. He first-authored a landmark 2009 Lancet article on minor head injury in kids. PV Card: Pediatric Blunt Head Trauma Adapted from [1] Go to ALiEM (PV) Cards for more resources. Update June 27, 2017 We collaborated with PECARN [+]
Trick of the Trade: Preventing tissue adhesive seepage
As great as tissue adhesives are in wound closure, they come with some risk. For instance, liquid adhesives, such as Dermabond, can "run" and contact undesired areas such as eyelid margins. Careful application of tissue adhesives is critical. How can you minimize the amount of seepage of tissue adhesive to undesired areas? Trick of the Trade Create an impermeable tape barrier I already mentioned this in an earlier post in July, but I now have more experience with this technique. Here are some recent photos of this trick in action. Cut out a circle from a transparent tape adhesive. In [+]