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I had a couple of excellent shifts with medical student/clerks this past week. So rewarding when a learner can have one of those "ah-ha!" moments that will have a lasting impact. Reminds me of why I love EM and why I love teaching so much. I'll review a few high points here. 1/n
1. It's common 4 learners & even staff MD to misapply HINTS exam & Dix-Hallpike test. HINTS should only be done on pt w/ constant vertigo (ie Acute Vestibular Syndrome); D-H only in pts w/ intermittent brief provoked vertigo. referred student to @PeterJohns84 great work!
2. If a patient has symptoms c/w an inguinal hernia, but ultrasound doesn't show anything, get a CT. (even CT isn't completely sensitive) If it walks, swims and quacks like a duck, it's probably a duck.
Bonus: I got to see my student reduce his first inguinal hernia! 3/n
Bonus: I got to see my student reduce his first inguinal hernia! 3/n
3. Anesthetizing a wound/lac for repair. Common error is to infiltrate lidocaine into outside of wound edges. It should injected INTO wound. Probably less painful and minimizes additional trauma of tissues around wound. Test anesthesia with toothed forceps, not the needle. 4/n
4. Sometimes body habitus and significant tissue edema around a distal radius fracture (Colles) makes it hard to ID the exact # site. I like to use US to find exact location if I am performing a hematoma block, and in my experience this leads to better results. 5/n
5. I love reducing fractures. Very satisfying. Also love when I have a handy ortho tech who will apply a perfect splint. What is more satisfying? Allowing the learner to do the reduction and apply the splint. 6/n
6. Sometimes clinician doesn't know what is going on w/ a pt. Either b/c there's no obv Dx or b/c pt not telling whole truth. Asking "FIFE" Q's (fears, ideas, feelings, expectations) will often bring answer right to you. (eg pt afraid they have cancer, had relative w/ it) 7/n
7. Finally, not all cases are boring. To borrow a teaching tip from the great @amalmattu , simply asking a "what if" question takes a simply muscular strain or uncomplicated UTI and makes it a challenging case.
I love this job.
8/8
I love this job.
8/8
