Trick of the Trade: Finger nailbed laceration repair

LacFingernailsmOver the years, I have been frustrated by how inelegant finger nailbed closure is. Nailbed lacerations are often sustained by a major crush injury, resulting in a stellate and irregular laceration pattern. This typically also requires the crushed fingernail to be removed. Cosmesis is never ideal because pieces of the nailbed are often missing, as seen in the photo above.

Occasionally, nailbed lacerations are caused by a cutting rather than a crush mechanism. In these cases, I use a different technique. I leave the fingernail on. In fact, I use the fingernail to help reapproximate the nailbed edges.

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2016-11-11T19:01:44-07:00

Top 10 tips when making your rank list

MakingList“How do I decide how to order the residency programs on my rank list?”

On Feb 24, 2010, every residency applicant will have a brief moment of panic as their rank list is submitted and officially certified.

Next week, I’ll be joining a group podcast with Dr. Rob Rogers (Maryland) and Dr. Dave Manthey (Wake Forest) for the next installment of EMRAcast. This new podcast series was created by Rob for EMRA for the specific purpose of providing advice to medical students. I still find it fascinating how much you can get done virtually. We’ll all be using Skype from our respective offices and recording our conversation.

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2019-02-19T18:08:25-07:00

Article review: Service versus education

ERwaitingroomIt’s a busy day in the Emergency Department and there are 5 new patients to be seen. The waiting room is overflowing. As the attending, you are getting barraged with a million questions to answer and problems to fix.

There is also a case of a full-thickness burn patient going to the OR in the next few minutes. She’d be a perfect teaching case for the residents.

Should I have the residents go see the new patients, or should I pull them all aside to show them the physical findings and teach about burns for 5-10 minutes?
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2016-11-11T19:01:45-07:00

Paucis Verbis Card: CNS Infections

PV Card: CNS Infections

Here is another installment of the Paucis Verbis (In a Few Words) e-card series on the topic of CNS infections from EM Clinics of North America 2009.

 


Adapted from 1
Go to the ALiEM Cards site for more resources.

1.
Somand D, Meurer W. Central nervous system infections. Emerg Med Clin North Am. 2009;27(1):89-100, ix. [PubMed]
2019-01-28T23:52:20-07:00

Paucis Verbis Project: A peripheral brain e-card series

PocketContentsCardsA few days I wrote about my “peripheral brain” note cards that I carry with me on each ED shift. These cards contain brief summaries of updated guidelines, evidence based literature, and clinical pearls. I constantly get requests for a copy of them, but they are fairly outdated now that I’m out of residency.

So starting today, I’m going to start periodically posting new note cards in Word and PDF format that can be printed on any 4×6 inch index card. These will be posted every Friday. Feel free to download, edit, change font or font size, and use. You can add/remove cards as you collect them. Comments are definitely welcome.

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2019-01-28T23:52:50-07:00