Apps

There are a ton of medical applications for your mobile devices...there's even multisensory apps with OrcaHealth appearing to be one of the leaders in this cutting edge technology. So, which one are you using? iMedicalApps.com appears to be an unbiased resource to help you make that decision. Here's some of Health WorldNet's favorites.

 Medgadget

Medgadget is an independent journal of the latest medical gadgets, technologies and discoveries. Our website is written, edited and published by a group of MDs and biomed engineers.

 Proceduralist.org

This site was created to teach medical students, residents and faculty common bedside procedures and point-of-care ultrasound.

Agitation

Richmond Agitation-Sedation Scale (RASS) ranks agitation and possibility for sedation.

Alcohol Withdrawal

The Clinical Institute Withdrawal Assessment of Alcohol Revised Scale - CIWA-Ar scale is the most sensitive tool for assessment of the patient experiencing alcohol withdrawal. Nursing assessment is vitally important. Early intervention for CIWA-Ar score of 8 or greater provides the best means to prevent the progression of withdrawal. Patients with scores ≤8 typically do not require medication for withdrawal.

Angioedema

Therapies for HAE attacks •icatibant — a bradykinin 2 receptor inhibitor •ecallantide — a kallikrein inhibitor (kallikrein is the enzyme that produces bradykinin from high-molecular-weight kininogen (HMWK)) •C1-INH concentrate — C1 esterase inhibitor blocks the pathways that produce HMWK (the C1-INH concentrate may be plasma-derived or recombinant)

Arthrocentesis

There is no definitive data demonstrating which landmark-based approach to a knee arthrocentesis is most likely to yield a successful aspiration - Anthony DeVivo DO

ASA Physical Status Classification

The purpose of the system is to assess and communicate a patient’s pre-anesthesia medical co-morbidities. The classification system alone does not predict the perioperative risks, but used with other factors (eg, type of surgery, frailty, level of deconditioning), it can be helpful in predicting perioperative risks.

Asthma

We all know the ABCs of resuscitation, but A doesn’t always come first. Asthma is a respiratory problem not an airway problem. Unless the patient arrives in arrest, there is no reason to intubate immediately. Adding plastic to the airway only makes things worse.

BRUE

Brief Resolved Unexplained Events is used only when another condition cannot be discerned as the etiology of the event. BRUE is still a constellation of symptoms that, in the end, may be attributed to a more specific diagnosis, but if you can be more specific at the outset, then do not label as BRUE.

Burns

Note that for children, the surface area of their head comprises a larger percentage of body surface area when compared to an adult, so the rule of 9s needs to be adjusted.

C Section Crash

A simplified approach to the initial emergency department assessment and management of pregnant patients in cardiac arrest.

CHEMM

Enable first responders, first receivers, other healthcare providers, and planners to plan for, respond to, recover from, and mitigate the effects of mass-casualty incidents involving chemicals

Chest Tube

This time round, we’re going to ‘own the chest tube!’ — as well as the chest drain and a few other things along the way…

Cyanokit

CYANOKIT (hydroxocobalamin for injection) 5 g for intravenous infusion is indicated for the treatment of known or suspected cyanide poisoning. If clinical suspicion of cyanide poisoning is high, CYANOKIT should be administered without delay.

Dental - Knocked Out Teeth

If unable to re-implant place in patients mouth- saliva is a great medium = Hanks solution > Milk > Saline. NEVER TAP WATER and DON'T LET THE TOOTH DRY OUT

Drugs & Breastfeeding

The LactMed® database contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate.

Drugs In Pregnancy

The experts behind MotherToBaby have created fact sheets that answer frequently asked questions about exposures during pregnancy and breastfeeding. MotherToBaby Fact Sheets are available in both English and Spanish and can be downloaded for free. Currently available fact sheets are listed below by category of exposure. All medications are listed by generic name. The generic name can be found on your prescription or medication packaging listed as the Active Ingredient, or in parentheses after the medication’s brand name.

eFAST

Ultimately remember that the EFAST exam is a rule-in test, not a rule-out test - it can rule in free fluid and pneumothorax, but a negative EFAST exam doesn’t rule out injury.

EMLA

EMLA is a topical mixture of equal amounts lidocaine (2.5%) and prilocaine (2.5%) that creates a dermal anesthetic. In mom speak: it’s the magic numbing cream.

Epiglottitis

Before starting efforts at intubating any airway with laryngeal pathology, it must be appreciated by all caring for the patient that rescue ventilation may not work if the epiglottis or larynx is swollen or distorted. This applies to the LMA, King LT, and mask ventilation.

Felon

Using your #11 blade start your incision 5mm distal to flexor DIP crease and end 5mm proximal to nail plate border. Digital arteries and nerves arborize near DIT. Avoid those!

Fishhooks

If forcing the barb through and then clipping it is too grisly for you, try the “backout technique” which can work with small fishing hooks… 1) Loop a 12-inch length of string or fishing line around the bend of the hook, and wrap the ends around the index finger of your other hand. 2) Push down on the hook shank to disengage the barb from the flesh. 3) Maintain pressure on the hook and align the loop with the shank. 4) Pull on the string and the hook will pop out through the entrance wound. 5) Treat with antiseptic.

Foley Placement

A clever technique for placement of a urinary catheter over a wire.

Glasgow Coma Scale

The phrase 'GCS of 11' is essentially meaningless, and it is important to break the figure down into its components, such as E3V3M5 = GCS 11. A Coma Score of 13 or higher correlates with a mild brain injury, 9 to 12 is a moderate injury and 8 or less a severe brain injury.

Glaucoma

Like high blood pressure, glaucoma is a devious disease - Langis Michaud

Hand Exam

The human hand is a fascinatingly intricate arrangement of pulleys, tendons, muscles, and nerves that work together in a complex system to perform daily tasks. It is often difficult to visualize the various paths that the tendons and muscles take. It can also make a thorough hand exam difficult to perform with proficiency. This post will review the clinically relevant anatomy of the hand, and apply it to both a screening exam and detailed exam with maneuvers used in the diagnosis of common hand injuries.

Hemophilia

I think that we would all agree that “bleeding” as the chief complaint catches your attention in the Peds ED (or any ED for that matter).

Human Bites

The goals of HB management are to minimize infection risk and its complications, and to prevent the transmission of systemic infections, such as hepatitis B/C and HIV - M Tabbara.

ICE

By adding ICE to your mobile phone it allows paramedics on the scene to identify you, treat you and be able to contact your next of kin immediately. Also, carers and parents can relax knowing, that should anything happen to their loved ones, medics will have all the information they need to give the right treatment, and they will know who to call first.

IOP

IOP measurements above 21 mmHg in the setting of ocular complaints are an indication for emergent treatment and referral - Melanie Yates MD

Mallampati Score

The Mallampati Score is a grading system based on the visualisation of the pharyngeal structures during laryngoscopy. A study of 210 patients confirmed the degree of difficulty in seeing three pharyngeal structures (uvula, soft palate and faucial pillars) as an accurate predictor of difficulty when using direct laryngoscopy.

Meningitis

Ultimately, outside of a positive CSF culture, no one test or exam should rule in or out the diagnosis of meningitis. A patient may or may not have all the aspects of the disease and we as clinicians have a duty to maintain that omnipotent high level of suspicion and clinical gestalt.

Methemoglobinemia

Methylene Blue 1-2 mg/kg (1% solution) over 5 min.

Neonatal and Infantile Common Skin Lesions

Some of the more common neonatal rashes. Good Luck!

Neonatal Jaundice

For years it has been stated that poor outcomes from a condition as treatable as jaundice should be a “never event - Donna Brezinski

NIH Stroke Scale

Excellent resource for quick scoring of the NIH stroke scale.

Ocular Ultrasound

Ocular ultrasound is a fast and simple technique that can be performed at the bedside to help differentiate between various ophthalmologic emergencies.

Paracentesis

Commercial paracentesis kits are pre-assembled. If you do not have a commercial kit, this is a list of the equipment you need to perform a successful paracentesis...

Pediatric Cardiac Arrest

"WET FLAG" - a nice mnemonic for the management of pediatric cardiac arrest.

Penile Zipper Entrapment

The method of removal depends on where the genital skin is entrapped. The skin of the foreskin or scrotum may become stuck in two main sites: •Between the teeth of the zipper •Within the sliding part of the zipper

Peritonsillar abscess drainage

This update reviews these tricks as well as some additional techniques for optimal success in draining a PTA, while avoiding the ultimate feared complication of puncturing the carotid artery.

Pneumothorax - Tension

Here’s a quick, 3 ½ minute video for physicians and paramedics on how to decompress the chest when you suspect a tension pneumothorax.

Post-Tonsillectomy Hemorrhage

Remember to push out laterally onto the tonsillar fossae (do not aim posteriorly) - Sean M Fox

Priapism

What's more concerning is that the priapism can potentially result in ischemia from sludging and clotting in the cavernosa. Irreversible impotence is another possibility. So yeah, it's an emergency, and uh, yeah, you've gotta drain it now. As it turns out, the procedure is not terribly difficult. You can break it down into a few steps...

QuikClot Combat Gauze

Proven on the battlefields of Iraq and Afghanistan, QuikClot® products put life-saving technology into the hands of US soldiers to treat hemorrhaging wounds. Originally engineered for military use, QuikClot® devices are impregnated with kaolin, an ingredient that stops bleeding fast when applied with pressure.

Retrobulbar Hematoma

Lateral canthotomy with cantholysis is the treatment of choice for decompression of the orbit after retrobulbar hematoma. The only contraindication to lateral canthotomy include suspected globe rupture - Courtney McKee, MD

Sepsis

Sepsis is the most expensive and deadliest condition we are battling in our hospitals. But when did you last see headlines trumpeting a blockbuster new sepsis drug? You haven’t — and you won’t — until we make a serious commitment to fight the oldest disease of all - Derek Angus

Skinsight

Skinsight is dedicated to providing quality health information to consumers via the Web. At Skinsight you have access to some of the best medical images in the world. We believe images combined with expert-written knowledge will help you better identify and understand a health concern than by simply using words. Health care is undergoing a revolution as patients have access to more and more information on the Internet.

Slit Lamp

We’ve collected the most high yield tips to get you examining like a pro. These are the hard things that all beginners struggle with.

Smartphone Physical

We empower the modern physician through mobile technology, and in the first demonstration of its kind, we're showing that it matters. We put vital signs, instant heart rhythm checks (ECG), even high definition photos of the back of the eye in any clinician's phone. The Smartphone Physical provides a unique glimpse into the future of the exam room.

Super Glue

Should Super Glue bond to any body part where acetone should not be applied, such as the lips or eyes, the following steps will help you get out of any sticky situation!

Suprapubic Catheter

Percutaneous catheter placement.

Tet spells

We are all familiar with Tetralogy of Fallot, primarily because it is a great topic for test writers to torture us with questions about. One of the cool things about pediatric cardiology is that it really makes you consider physiology and plumbing… ok… maybe I’m just a geek. But, before you judge me too harshly, let us consider the Hypercyanotic Spell (aka, ‘Tet spell’).

Thoracentesis

Get the standard thoracentesis kit. In addition to the kit, you will need two 1-liter vacuum bottles and Bethadine for cleaning the area.

Thoracic Vent

UreSil is a leading global provider of innovative devices for the specialized field of interventional radiology. We manufacture an extensive line of drainage and specialty catheters...

Thyroid Storm

Thyroid storm is very rare, so the main challenge is considering it - Josh Farkas

Tick removal

Many of us feel it’s best to inject Lidocaine under the tick using a small bore insulin style syringe/needle, then pull it out.

Transfusion Reaction

While the incidence of severe transfusion reactions is 0.09% (1/1111), the total incidence of all transfusion reactions is approximately 0.25% (1/400). Therefore, the likelihood that each emergency physician will see one is high, and we should all know the presentation, evaluation, and management of these complications.

Trauma Resuscitation

There is a mantra to resuscitation – address the “ABCs” – that has been taught for years and still has a firm place in the traditional life-support courses... for trauma, we must change our approach. We have the benefit of learning from our military colleagues and advancing our own civilian practice to what makes physiologic sense.

Tylenol OD

N-acetylcysteine (NAC or Mucomyst) is the specific antidote for acetaminophen toxicity. NAC given before 8 hours post-ingestion eliminates mortality and brings morbidity to a few percent (the 8-hr window).

Tylenol Peds Dosage

Meltaways. Tabs that dissolve come in 80 mg and 160 mg (jr. strength) Suppositories. Come in 80, 120, 325 and 650 mg. The rectal dose is the same as the dose given by mouth.

Ultrasound

This online website was a creation of members of the American College of Emergency Physicians (ACEP) Section on Emergency Ultrasound under the direction of Beatrice Hoffmann, MD, PhD, RDMS and the coauthors listed over a period of 3 years. Created to educate at the undergraduate level, the project became a sophisticated and comprehensive reference with state-of-the-art graphics that serves any level of medical training and continuing medical education.

Urethral Catheterization

Urologists frequently address difficult urethral catheterization (DUC), which may be due to obstruction, constriction, false passages, urethral stones, urethral strictures, phimosis, anasarca, bladder neck contracture, benign prostatic hyperplasia (BPH), and other more rare causes.[1,2] To facilitate successful catheterization in these situations, a wide variety of catheters differing in style, shape, size, and material have been manufactured (Coudé, council-tip, silicone, etc.).

VBGs

This review will break down blood gas results into individual components to compare venous versus arterial results and evaluate whether these are clinically important differences.

Vertigo - Half Somersault Manuever

Benign paroxysmal positional vertigo (BPPV) frequently recurs after treatment, so a home exercise would be desirable. We designed a self-administered exercise, the half somersault, for home use. In this randomized single-blind study, we compare the efficacy of our exercise to self-administered Epley maneuvers in patients with BPPV.

Vision Loss

Today’s Q&A’s will bring together all the different ways the ‘lights can go out’ — don’t forget keep your ultrasound machine handy. Are you ready for the ‘out of sight / loss of vision challenge’?

VP Shunt tap

Attach 25 G Butterfly needle’s tubing to 3-way stop-cock and manometer. Insert butterfly needle into the reservoir. Advancing slowly. Hold manometer at level of the patient’s ear.

VP Shunt tap

A young girl with a ventriculoperitoneal shunt presented to the emergency room after several days of headache and now altered mental status. CT scan demonstrated severe hydrocephalus. In this video we demonstrate how to do a diagnostic tap of the VP shunt.

Wide QRS Complex

Provide procedural sedation (e.g. propofol IV) prior to electrical cardioversion (e.g. synchronous, 100J biphasic)...In general, if you don’t consider magnesium as a potential therapy for a condition you are not an emergency physician.

ZeroWet

ZEROWET is the leader in wound irrigation products. Wound irrigation is all we do. That's why we do it best! And now, we do it even better!