Archive for February 2nd, 2010
Brush up on your Ultrasound skills with the iPhone Sonosite app
Posted by Harvey Castro, MD in ACEP Updates, Apps, Critical Care, ED Management, Informatics, Information Technology, Medical Malpractice/Risk Reduction, Residency, TheCentralLine.org, Tricks of the Trade, Twitter, Ultrasound on February 2nd, 2010
Sonosite has released a FREE iPhone app that will help improve their ultrasound skills.
The videos are amazing! Containing many tips, pointers on techniques, great sample cases, image gallery.
The app even has an abbreviated manuel for the Sonosite. The app also contains the latest news concerning sonosite machines.
Here are some screen shots:
For a sample video click here
If you do not like the app, you are out time but not money.
Fear and Loathing in D-Dimer
Posted by Graham Walker, MD in Drugs and Treatments on February 2nd, 2010
Am I the only one who hates the d-dimer for pulmonary embolism? I can’t imagine that I am. It was supposed to reduce our number of CTs, but the data suggests that it has instead increased them. (Full disclaimer, I never practiced in the days of V/Q scans or the days without d-dimer, but this is what I’m told.)
I find my practice pattern typically using the PERC Rule and/or Well’s Criteria for PE to identify well-appearing people who are “very low risk,” who would likely be harmed more than benefitted by a d-dimer test. And then for low-risk, I’ll end up using a d-dimer.
But when the computer screen blips that the result is back, I get a similar little blip in my chest, hoping it’s going to be negative. Interesting that I feel this way, given that I have no other reaction like this, except occasionally while waiting for the altered patient’s rectal temperature.
On one hand, I wonder, if this is the reaction I’m feeling, hoping and trying to mentally will the number to be negative when I click the “View Results” button, should I have even ordered the test to begin with? And on the other is how atypical, nefarious, and sometimes-weird presentations of pulmonary embolism can be. And then on the third hand: is the pulmonary embolism in the otherwise healthy, young, well-appearing person actually cause for alarm? (Some experts would suggest that our bodies are in a constant state of coagulation/anticoagulation, and that we’re all walking around with occasional, small PEs that our lungs dissolve or filter.) Maybe this is different (“benign PE”) from the PE in the cancer patient, or the hypotensive patient, or the one with the saddle thrombus. And on the fourth hand: there’s not even any good data that anticoagulation is of any benefit in pulmonary embolism (even though it’s the standard of care, and we all still give it).
Maybe I just hate PEs, or ruling them out in seemingly low-risk patients: the time, the money, and most of all, the contrast load and radiation exposure. But for now, I guess we’re stuck with our imperfect tests, clinical gestalt, and bedside evaluations of risk and benefit.
Emergency Room Communication
Posted by Harvey Castro, MD in ACEP Updates, Apps, ED Management, Informatics, Information Technology, Medical Errors, Medical Malpractice/Risk Reduction, Residency, TheCentralLine.org, Triage, Tricks of the Trade, Twitter, Uncategorized on February 2nd, 2010
One of the key ingredient to running an efficient Emergency Room is good communication. Depending where you work finding charts, immediately finding a nurse or calling radiology can take longer than expected. Huntington Hospital is currently using an Iphone/Ipod device that allows the health care staff better communicate with each other. It does this via VOIP (Voice over Internet Protocol), basically the set up the system in the hospital to call each other using these devices instead of the hospital PBX or screaming across the ER. The Voalte One system provides voice, alarm and text services all on one device. Overall helps reduce the noise level and makes it easier for the staff to text each other or call each other.
Over all points:
- Receive Voice calls, alarms, and text messages all on a single device
- Easily manage multiple text message conversations
- Intuitive user interface and ringtones
- Allows simple alarm acceptance or rejection
- Custom, user-generated “quick messages” facilitate instant messaging of common items to other users or a web-based client
Overall I see both pros and cons, on one side I think it would be useful to have one device to do it all.
On the other side, I worry that it might make it to easy to interrupt us from patient care. In the end it is all about the balance act.
Huntington Hospital is a 636-bed trauma hospital. For more information, visit www.huntingtonhospital.com
Company website: www.voalte.com
