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Recent posts

5 Ways to Add Value as an EM Sub-Intern

As medical students it can be hard at times to find ways to contribute to the care of our patients and teams. Sure, we see and evaluate patients on our own, but that doesn't preclude a more senior member from also doing their own evaluation, work-up, and note. Most everything we do needs to be approved or observed: our orders must be signed, procedures must often be carried out under watchful eyes, and patients are sometimes (understandably so!) unwilling to let the junior members of the team practice basic skills on them. When you know that asserting yourself in the care of your patient requires everyone else to chip in, it is easy to feel like a burden rather than a team player, especially in the fast-paced and busy environment of the emergency room.
The flip side, of course, is that if you can find a way to carve out a niche for yourself by owning certain areas of your patients' care, you can work within the team to ease the workload of everyone around you and drive patient …

Review: HINTS to Diagnose Stroke in the Acute Vestibular Syndrome

AVS is characterized by rapid onset of vertigo, nausea/vomiting, and gait unsteadiness with head motion intolerance and nystagmus.The most common cause tends to be viral in nature, affecting the inner ear.While this may be the domain of our esteemed neurology colleagues, there are 2.6 million ED visits for dizziness or vertigo annually in the United States, where the differential between a benign viral cause of vertigo or dizziness must be delineated from potentially lethal causes such as brainstem or cerebellar strokes.
Vertigo and dizziness, especially in cases of labyrinthitis, is caused by inflammation along the semicircular canals, affecting the flow of fluid throughout the system and causing the brain to interpret tilt or head spinning when there is none.However, these same systems can be disrupted by central nervous pathologies that affect the vestibulocochlear nerve or the pons, which CN VIII enters.Acute stroke in the vertebrobasilar circulation along the brain stem can presen…

Giving Good Sign-out

Whether it is in the Emergency Department or on the floor, the patient hand-off is one of the most dangerous times in a patient's hospital stay. A review of the causes for medical error finds that problems with communication during transitions in care is a common source of mistakes: vital information gets lost, forgotten, or communicated incorrectly leading to potential safety issues.  eD-PASS is a standardized tool to help you give clear and consistent sign-outs during your rotation in the ED. You can download it onto your mobile device here.

Emergency Medicine Website Update!

The Emergency Medicine sub-internship website has been updated!!  Our goal is to expand the online resources available to you, and create a place for medical students to find help with everything from, how to succeed during your EM clerkship, applying for away rotations. how to get letters of recommendations and your ERAS application.

You can find all these new resources in the left menu under a section called 'Preparing for your EM sub-i" Don't forget to follow this blog to keep up to date on both education and application resources, and if  you have a great resource or want to share something with our EM student community please send it our way!

Which Picture Do I Want?

If dispo is king in the ED, the plan is the prince. But imaging plans can be tricky. You want to look at someone's abdomen, sure. But CT or MRI? Or is this one of the rare instances plain films help? Do they need IV contrast? PO contrast?

By no means exhaustive, the guide below outlines common points of confusion with radiology.

-AP vs PA Lateral: The "AP" or "PA" refers to the direction the beam is traveling to the receiver - either anterior to posterior (AP) or posterior to anterior (PA). Despite this being an x-ray this matters because is changes the observed size of images. Imagine your lamp is the x-ray beam and your desk is the receiver: putting your hand close to the desk results in a small hand shadow, moving it towards the lamp increases the size of the shadow. Why we care about this happening at all is the cardiac shadow on a chest x-ray. When the beam goes AP the heart, being more anterior, casts a bigger shadow that may overemphasize the heart …

IV Tips

Make your sticks stick.

This is a Haiku Deck full of tips from NYP ED nurses on how to get good at starting IV's. These nurses do this all day every day. They know what they're about.

Click here to go to the full version including the full length tips and tricks!

EM Bound - Created with Haiku Deck, presentation software that inspires

Further Reading:
The Anesthesia Consultant Blog with some tips for difficult sticks.
Songs or Stories on pediatric IV tips (that apply to adults equally as well).