Trick of the Trade: The defensive arts against pimping
Thanks to Dr. Rob Roger’s podcast on EM-RAP Educator’s Edition series, I learned of one of the funniest publications EVER in a medical journal. It was published on April 1, 2009 in JAMA. The article focuses on teaching medical students the essential skill set– how to survive “pimping”. Pimping traditionally occurs when an attending physician poses a difficult question to a learner in a public forum, such as board rounds or in the operating room. As a student or resident, you know that this will happen during your training, and you should be prepared. If you think of pimping as [+]
Article Review: Learning assessment using virtual patients
I am developing a new microsimulation module to help EM clerkship students gain a more realistic exposure to high-acuity patients. Emergent conditions, such as ectopic pregnancy, acute tricyclic overdose, and ST elevation MI, are usually cared for by senior residents and attendings. Rarely are students primarily involved in these cases. [+]
A radiology pearl: A subtle orthopedic diagnosis
A man recently presents with knee pain after pivoting and torquing his knee while falling. He complains of concurrent mild ankle pain. He presents with this tib-fib xray. Realizing that a proximal fibular fracture can present concurrently with a medial malleolus fracture or deltoid ligament rupture, we obtained xrays of the ankle. We were looking for a Maisonneuve fracture. Do you see an ankle injury in these four images? [+]
Trick of the Trade: Don’t have a mirror in the ED?
Several times in the ED, I have needed a mirror for patient care. Example 1 A moderately intoxicated patient presents with a facial or scalp laceration. S/he adamantly refuses to have it repaired in the ED, because of the disbelief of that there is indeed a laceration. You want to show the patient, using a mirror, but you don’t have one. [+]
Article review: How do you assess the quality of educational research articles?
Imagine this. You are about to conduct an innovative educational project and want to get a research publication out of it. What are considered strong methodological qualities of an educational research study? What can you do to improve your chances for publication?The authors in this study developed and use an instrument to help measure the methodological quality of quantitative studies in medical education. This instrument, the Medical Education Research Study Quality Instrument (MERSQI), was used to show that scores were predictive of manuscript acceptance into the 2008 Journal of General Internal Medicine (JGIM) special issue on medical education.What is the [+]
Trick of the Trade: Easy ocular application of fluoroscein
Gently instilling a fluorescein drop into a patient’s eye requires that the patient keep his/her eye still. What do you do for a patient who can’t quite stay still enough, such as an infant? This is an innovative trick of the trade, written by Dr. Sam Ko (Loma Linda EM resident) and Kimberly Chan (Loma Linda medical student). [+]
Trick of the Trade: Super-sensitive to eyedrops
We commonly encounter ocular complaints in the Emergency Department. Eye pain can result from chemical exposure, a foreign body, or infection. The first step involves instilling a few drops of topical anesthetics, such as proparacaine, to provide some pain relief. Occasionally, however, you encounter a patient who just can’t keep his/her eye open because of the fear of eyedrops. [+]
Article review: Bedside teaching in the ED
Bedside teaching is a unique educational skill, which academic faculty are often assumed to just know how to do. In the ED, it is especially difficult to do this well, because of crowding and unexpected time-sensitive clinical issues, which create distractions and general chaos. Experientially, unpredictable clinical issues negatively impact bedside teaching. Thus, faculty should be flexible and knowledgeable of basic bedside teaching tenets. [+]
Tricks of the Trade: Low tech solutions to esophageal foreign bodies
Patients can present to Emergency Departments with esophageal foreign bodies. Recently, a patient presented with a doxycycline pill stuck in her esophagus at the mid-chest level. She was taking it for pneumonia. Despite drinking deluges of water for the past 12 hours, the pill remains stuck. You know that doxycycline (pills shown on right) is one of several medications (along with iron or potassium supplements, quinidine, aspirin, bisphosphonates) known for causing erosive pill esophagitis. She presents to your ED. What do you do? With so many direct visualization tools in the ED now available to emergency physicians such as Glidescopes [+]
Article review: Handoffs in the Emergency Department
One shared experience amongst all emergency physicians is the “handoff” or “signout” of patients at the end of your shift to the oncoming physician. A recent article in Annals of Emergency Medicine explores and explains how this process can often lead to delays and errors in patient management. Just envision ED handoffs as a high-stakes game of Telephone, which you played as a child. [+]