Sneak Peak "Trick of the Trade": Digital nerve block
The digital nerve block is common performed in the Emergency Department to provide anesthesia prior to wound closure. The digital nerves are typically accessed by injecting in the webspace on either side of the finger. Have you had patients start to get sweaty and anxious merely at the sight of your drawing up lidocaine in the syringe? Despite your reassurance that the 18-gauge needle that you used was just to move the lidocaine into the syringe and that you’ll be using a small needle for the procedure, they don’t look very reassured. Trust is key to having the procedure go [+]
Article review: CT irradiation exposure and risk
I’m still working on my 2009 ACEP Scientific Assembly handout for the LLSA exam test prep session (which were actually due yesterday!). Even though the conference isn’t until mid-October, the handouts are always due a few months earlier. And every year, it sneaks up on me! One of the articles I’m reviewing is about the risks of CT irradiation, published in the New England Journal of Medicine in 2007. [+]
Article review: Propofol (2007 ACEP Guideline)
Given all the recent brouhaha around propofol and Michael Jackson, I thought I would review the 2007 Annals of EM Clinical Practice Advisory paper on the use of propofol in the Emergency Department for procedural sedation. This is one of the 2009 Lifelong Learning Self-Assessment (LLSA) articles. Each year EM-board certified physicians are tested on 20 pre-selected LLSA articles to maintain eligibility for re-certification. [+]
A Lexicon for the Workplace
We have many Research Associate volunteers who staff the SF General Emergency Department collecting research data. They are often ask "what did you mean when you said..." or "what does that mean on the patient census whiteboard". When I answer their questions, they often chuckle. This then made me realize that we routinely use terms and phrases that aren't part of the usual medical vocabulary and are unique to the SF General ED. HACito: For acutely agitated patients (often under the influence of one or more intoxicants), we commonly use Haldol, Ativan, and Cogentin in a single syringe to inject [+]
Tricks of the Trade sneak peak: Teaching procedures
Teaching procedural skills in medical school is increasing falling on the shoulders of emergency physicians. Two common problems that arise are the equipment expenses and simulation of realism. Working with my colleague Dr. Jeff Tabas, we came up some creative ideas around the teaching of (1) the Seldinger technique for central line placement and (2) saphenous vein cutdown. [+]
Article review: The ABCs of manuscript writing
I came across a practical and insightful review article written by Dr. Mark Langdorf (editor-in-chief of West JEM) and Dr. Steve Hayden (editor-in-chief of Journal of EM) outlining how to write a manuscript for publication. This is a crucial skill because paper publications are the standard unit of currency in academics, which then translates into promotions and academic credibility. Although this article primarily targets novice manuscript writers, it’s always nice to get the perspectives from Mark and Steve, editors-in chief of two major EM journals. [+]
Three phases of educational technology in the classroom
I recently encountered a thought-provoking video about how technology is transforming education in the classroom setting. We are slowly experiencing a culture shift in how learners are learning. It follows that this should affect how teachers should be teaching. Briefly, the author lays out the progression of educational technology in 3 phases. [+]
Trick of the Trade: The Digi-Speculum
Frequently patients present to the Emergency Department for lacerations, partial amputations, and abscesses of the fingers. After repairing the wound or injury, however, a bandage can be a bit unwieldy to apply and difficult to secure. To me, an ugly bandage just seems to detract from all of the diligent work that you just put into a plastic surgeon-quality wound repair. [+]
Work in Progress: Visual Aid Project
Practicing at an academic ED, such as in San Francisco General, I find that I am constantly surrounded by medical students, interns, and residents. Most are working on shift with me, but occasionally I have medical students shadowing me to learn more about the Emergency Medicine specialty. Have you ever had a person shadow you (excluding your annoying little brother when you were a kid)? It’s actually a little stressful for me, because I want the shift to be a positive learning experience for them. Inevitably, it doesn’t take long before I get immersed in mundane troubleshooting activities (eg. calling [+]
Article review: Standardizing the EM clerkship patient encounter experience
As a medical student, do you remember your EM clerkship experience and whether you saw a wide variety of patient chief complaints? Did your fellow medical student on the EM clerkship rotation, who was going into Orthopedics, seem to only see patients with orthopedic complaints? [+]
