Just the Facts: Assessing How Trainees Gather Info

The Pediatric Milestones are now being used to guide the ongoing evaluation of trainees in all rotations. The most important Milestones vary from rotation to rotation. In the Pediatric Emergency Department (as in many others) making sure that you obtain the right history is key to assuring that you can develop an appropriate differential diagnosis and plan. Levels of Experience and Learning In general, early learners—for example interns—rely on basic pathophysiology and use analytic reasoning to generate mental maps to try to link their history and the exam. This history can be too extensive Read more [...]
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Answer: ‘Not So FAST!’

This post is in response to the post “Not so FAST!” To summarize, this was a 10-year-old boy complaining of abdominal pain after flipping over his handle bars while riding a bike.  An eFAST is performed and the following image of the right upper quadrant is obtained: Thank you to everyone who took the quiz! For question #1, 57% of you guessed correctly that there is free fluid in Morison’s pouch.  While this image is technically limited in that you can not fully visualize both the subphrenic recess (14%) or the inferior pole (24%), there is free fluid visualized in Morison’s Read more [...]
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Not so FAST!

A 16-year-old boy was trying to do a sweet jump off his friend's brand new Sledgehammer bike... But unfortunately, he was not as successful as his friend Pedro and is brought into your ED by EMS after flipping over his handle bars. He is alert and oriented, and hemodynamically stable. He denies any loss of consciousness but complains of abdominal pain. You perform an eFAST and obtain the following image of the right upper quadrant. Thank Read more [...]

MD Cents: Time is on My (and YOUR) Side…

  The words in the title are from a song made famous by the Rolling Stones. These guys are pretty remarkable. They are fixtures of the rock and roll scene and are still touring even though they are in their 70's! (As a matter of fact, they just played a show in my hometown to over 50,000 fans) Time certainly seems to be on their side when it comes to longevity but today I want to talk about how time IS on YOUR side with regards to finances. Time is the one of the greatest factors when it comes to helping you accomplish whatever financial goals you have. Time allows your money to experience Read more [...]

Who is the “Bad” Doctor?

During fellowship, I witnessed a very unusual thing:  the questioning of an internist in a courtroom in a malpractice suit. The plaintiff's lawyer was asking multiple questions, most of which were inquisitive about the nature of our work or the meaning of certain medical terms. The physician was being questioned by a lawyer before a jury lacking expert knowledge in both medicine and law. Since then I have been asking myself this question and what it really means to be “good” or “bad” in our profession.Shortly after that experience, I began my work as a pediatric emergency physician. I Read more [...]
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Answer: “Hips Don’t Lie”

  This post is in response to the post “Hips Don’t Lie” To summarize, this was 3-year old boy who presented with inability to bear weight on his right leg.  A hip ultrasound was performed and the following images were obtained: Thank you to everyone who took the quiz! For question #1, 87% of you guessed correctly that "B was the affected side", as evidenced by the large hip effusion measuring > 5mm.  4% of you thought that A was the affected side, 9% thought both were abnormal and none of you thought both were normal. Sonographic criteria for a positive Read more [...]

The drones are coming!

This post continues the July CPR technology theme. Nope- I'm not referring to the fresh crop of interns, 1st year fellows, or other newbies that grace the hospital system each July.  "Sure, I'd be happy to come in an assess that right lower quadrant pain before you order imaging".  I'm actually speaking about those flying quad captors that will deliver us packages, spy on our every move - and one day may help us to make a dent in out-of-hospital survival from cardiac arrest.  Check out this quick vid below to see the concept in action: Survival Read more [...]
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Hips Don’t Lie

A previously healthy 4-year old boy is brought in by his parents because they noticed that he has been refusing to walk since this afternoon when they came home from work.  He had previously been doing well but parents noticed over the past few days he has been complaining of right leg pain without any limitation in his activity until today. He was in school all day but there was no reported trauma.  Aside from that, the child has not had any fevers, cough, runny nose, vomiting, diarrhea, abdominal pain or rash. He is well appearing and cooperative with your exam, as he is well distracted Read more [...]