ALiEM Expert Peer Reviewed Posts in 2014

ExpertPeerReviewStamp2x200Last year, we launched a new initiative to bring on solicited Expert Peer Reviewers (EPR) for selected posts. These reviewers would need to have specific credentials, such as having previously published in a journal or textbook, presented the topic at a national conference, or have extra training in the area. In fact, we have added this as an required feature for all posts which have come through our New Submissions process. We wish to thank all our expert peer reviewers, who have kindly provided their open comments, which have significantly added to the educational value of the post. Below lists the 22 ALiEM expert peer reviewed posts in 2014:

 

Date Post Author Expert Peer Reviewer
Jan 15, 2014 Approach to Difficult Vascular Access Terrance Lee John Litell
Jan 23, 2014 Head injury in pediatric patients: To CT or not to CT? Josh Easter Lise Nigrovic
Feb 3, 2014 Serotonin Syndrome: Consider in the Older Patient with Altered Mental Status Christina Shenvi Debra Bynum
Feb 11, 2014 When the PERC Rule Fails Jason West Jeffrey Kline
Apr 1, 2014 Cellulitis: Do Not Get Blood Cultures Jeff Seigler William Paolo
Apr 3, 2014 High Sensitivity Troponin T and Acute Myocardial Infarction: One and Done? Salim Rezaie Anand Swaminathan
Apr 10, 2014 Top 10 reasons NOT to order a CT scan for suspected renal colic Daniel Firestone Ralph Wang, Renee Hsia
Apr 11, 2014 PEITHO Trial: Fibrinolysis for Intermediate-Risk Pulmonary Embolism Salim Rezaie Anand Swaminathan
Apr 17, 2014 Trick of the Trade: Making your own homemade ultrasound gel Christine Riguzzi Allison Binkowsi
Apr 29, 2014 Geriatric Emergency Departments: Coming to a Hospital Near You? Christina Shenvi Christopher Carpenter
Jun 13, 2014 PV Card: Local anesthetic toxicity calculations David Murphy Zlatan Coralic
Jul 9, 2014 PV Card: Pediatric Ingestion Dose Thresholds for ED Referral Bryan Hayes Zlatan Coralic
Aug 6, 2014 Management of Iron Toxicity Mary Wittler, David Manthey Todd Chang
Sep 10, 2014 Small bowel obstruction: Diagnosis by ultrasonography Jacob Avila, Jessica Whittle Matt Dawson
Sep 11, 2014 US4TW Case: 28F with Shortness of Breath Jeff Shih, Kennedy Hall Mike Stone
Sep 29, 2014 Bleeding and Hemophilia in the Pediatric ED Sarah Melendez Don Eslin
Oct 14, 2014 Blunt Chest Trauma: Validation of the NEXUS Chest Rule Eric Morley Robert Rodriguez
Oct 28, 2014 US4TW Case: 30M with Blunt Abdominal Trauma Jeff Shih, Kennedy Hall Arun Nagdev
Nov 5, 2014 Mythbusting the Banana Bag Meghan Groth Bryan Hayes
Nov 19, 2014 Why Henderson and Hasselbalch Belong in the ED Frank Ruiz Scott Weingart
Nov 20, 2014 Ultrasound For The Win! Case – 93F with Chest Pain Jeff Shih, Kennedy Hall Mike Stone
Nov 24, 2014 Can Permanent Marker Leach into IV Infusion Bags? Jeremy Bair, Cortney Hebert, Rob Bryant Angela Whitney

 

Author information

Michelle Lin, MD

ALiEM Editor-in-Chief

Editorial Board Member, Annals of Emergency Medicine

UCSF Academy Endowed Chair for EM Education

UCSF Associate Professor of Emergency Medicine

San Francisco General Hospital

The post ALiEM Expert Peer Reviewed Posts in 2014 appeared first on ALiEM.

Diagnose on Sight: Painful Scrotal Swelling

painful-scrotal-swelling-censored-350Case: A 48 year old male with a history of alcoholism presents with one day of painful scrotal swelling. What is the most important next step in management? Please read below for un-censored image. 

 

 

Uncensored Image

Poll

 

Answer

Consult Surgery for Fournier’s Gangrene

Explanation

There are few urologic emergencies that are more important to quickly recognize than Fournier’s gangrene. A necrotizing infection of the perineum, Fournier’s is usually caused by a polymicrobial infection. The condition is life-threatening with a mortality rate up to 22% despite aggressive therapy [1].

The infection has a predilection for diabetic, alcoholic, and immunocompromised patients. It commonly starts as a cellulitis of the perineum or perianal region accompanied by significant pain and swelling. Systemic signs are common, often “out of proportion” to the local extent of disease. Crepitus can develop due to gas forming organisms. It can quickly spread to involve the scrotum, penis, and abdominal wall before progressing to extensive necrosis, sepsis with multiple organ failure, and death [2].

Emergency physicians should immediately consult a surgeon and start broad spectrum antibiotics [3].

 

Master Clinician Bedside Pearls

Dr Anton Helman, CCFP(EM)FCFP
Assistant Professor
University of Toronto
Founder & Host of EM Cases podcast

 

 

References

  1. Kessler CS, Bauml J. Non-Traumatic Urologic Emergencies in Men: A Clinical Review.  West J Emerg Med. 2009 November; 10(4): 281–287. PMCID: PMC2791735.
  2. Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, Mammen K. Fournier’s gangrene and its emergency management. Postgrad Med J. 2006 Aug;82(970):516-9. Review. PMID: 16891442
  3. Shyam DC, Rapsang AG. Fournier’s gangrene. Surgeon. 2013 Aug;11(4):222-32. PMID: 23578806.

Author information

Jeff Riddell, MD

Jeff Riddell, MD

Chief Resident

UCSF-Fresno Emergency Medicine Residency

The post Diagnose on Sight: Painful Scrotal Swelling appeared first on ALiEM.

AIR Series: Psychiatry Module 2014

Welcome to the fifth ALiEM Approved Instructional Resources (AIR) ModuleALiEM-AIR-Badge only 200x200! In an effort to reward our residents for the reading and learning they are already doing online we have created an  Individual Interactive Instruction (III) opportunity utilizing FOAM resources for U.S. Emergency Medicine residents. For each module, the AIR board curates and scores a list of blogs and podcasts. A quiz is available to complete after each module to obtain residency conference credit. Once completed, your name and institution will be logged into our private Google Drive database, which participating residency program directors can access to provide proof of completion.

AIR Stamp of Approval and Honorable Mentions

In an effort to truly emphasize the highest quality posts, we have two subsets of recommended resources. The AIR stamp of approval will only be given to posts scoring above a new, strict scoring cut-off of ≥30 points (out of 35 total), based on our scoring instrument. The other subset is for “Honorable Mention” posts. These posts have been flagged by and agreed upon by AIR Board members as worthwhile to highlight regardless of the point score (but still reflect accurate, appropriately referenced, and unbiased content). All posts will still be part of the quiz needed to obtain III credit.

AIR Series: Psychiatry

Below we have listed our selection of the 5 highest quality blog posts within the past 18 months (current as of October 2014) related to Psychiatry, curated and approved for residency training by the AIR Series Board. In this module we have 1 AIRs and 4 Honorable Mentions. We strive for comprehensiveness by selecting from a broad spectrum of blogs from the top 50 listing per the Social Media Index.

After reading, please take the quiz. Feel free to ask questions in the blog comment section below. The AIR Board faculty will answer them within 48 hours of posting. Be sure to include your email or contact information where requested in the Disqus blog comment area, so that you will be notified when we reply. We recommend programs give 2 hours (just over 20 minutes per article) of III for this psychiatry module.

 

Article TitleAuthorDateLinkTitle
Serotonin Syndrome: Consider in the Older Patient with Altered Mental StatusChristina Shenvi, MD PhDFebruary 3, 2014ALiEM: Serotonin SyndromeApproved Instructional Resource
SGEM #45: Vitamin H (Haloperidol for Psychosis)Dr. Anthony (Tony) Seupaul, MDSeptember 20, 2013Skeptics Guide: HaldolHonorable Mention
Anxiolytics and Hypnotics: Are They Doing Harm?William Paolo, MDJuly 2, 2014ALiEM: Anxiolytics Honorable Mention
Droperidol Never Killed AnyoneRyan Radecki, MDFebruary 12, 2014EMLitofNote: DroperidolHonorable Mention
Eating DisordersSean M. Fox, MDAugust 22, 2014PedEMMorsels: Eating DisordersHonorable Mention

red_pencil_horizontal_pc_400_clr_3248

Take the quiz below, or click HERE to take you to the quiz site.
Be sure to enter your name and program, if you desire III credit.


Do you belong to a residency program that is not currently participating? No problem! Any one can read the AIR series curated post and complete the quiz for educational value!

If a residency program is interested in participating, please contact us!

Author information

Andrew Grock, MD

Andrew Grock, MD

Associate Director/Co-Founder of ALiEM Approved Instructional Resources (AIR)

PGY-4 EM resident

Kings County Hospital Emergency Medicine Residency

The post AIR Series: Psychiatry Module 2014 appeared first on ALiEM.

US4TW Case: 74F with Right Arm Tingling

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this peer-reviewed case series, we focus on real clinical cases where bedside ultrasound changed management or aided in diagnoses. In today’s case, a 74-year-old woman presents to the Emergency Department with painful right arm paresthesias.

CASE PRESENTATION

A 74-year-old female with history of atrial fibrillation presents to the Emergency Department with 45 minutes of painful right arm tingling that are now resolving. She has been off warfarin for the past 2 weeks for knee surgery. She reports no right arm weakness or color change. She reports left shoulder pain 12 hours prior to presentation. No complaints of shortness of breath or chest pain.

VITALS

  • BP 150/52 mm Hg left arm, 30/- mm Hg right arm (automatic BP cuff)
  • P  96 bpm
  • RR 18 respirations/min
  • O2 94% on room air (left arm); 85% on room air (right arm)
  • T 37.3 C

PHYSICAL EXAMINATION

  • Right arm:
    • No palpable radial or brachial pulses
    • Normal strength and sensation
    • Capillary refill 3 seconds
  • Left arm:
    • Normal radial and brachial pulses
    • Normal strength and sensation
    • Capillary refill <2 seconds
  • Lower Extremities:
    • Normal and symmetric bilateral femoral, posterior tibial and dorsalis pedis pulses.
    • Normal strength and sensation bilaterally
  • Cardiac and lung exams:
    • Normal

DIFFERENTIAL DIAGNOSIS

  • Arterial thromboembolism of right arm
  • Stroke/cerebrovascular accident
  • Thoracic aortic dissection

FURTHER STUDIES

Labs revealed a subtherapeutic INR of 1.5. A CT angiogram of the chest and abdomen was performed due to concern for possible dissection versus thromboembolism, and revealed:

  • No evidence of thoracic aortic dissection
  • Normal right brachiocephalic artery seen to axillary artery
  • Multiple areas of atherosclerotic disease

POINT-OF-CARE (POC) ULTRASOUND

Given the ongoing concern for possible thrombo-embolic disease, a point-of-care ultrasound of the right upper extremity was performed:

 

Axillary artery visualized with pulsations in B-Mode (left) and with color doppler (right)

 

 clot

With significant external compression with the probe, a visualized thrombus (blue arrow) is seen within a non-compressible brachial artery

ULTRASOUND IMAGE QUALITY ASSURANCE (QA)

Ultrasound evaluation of the vascular system in the extremities is performed using the high-frequency linear transducer. It is important to optimize positioning of the patient when performing any point-of-care ultrasound; when evaluating the vessels of the upper extremity, the patient should be supine, with the shoulder abducted and externally rotated, and elbow flexed [1]. Evaluation should include vessel identification, and assessment of vessel compressibility and blood flow. When using B-mode (normal gray scale) the angle of the probe in relation to the vessel should be as close to 90 degrees as possible, which will improve the definition of the vessel as well as the clot. Color doppler is used to assess direction of flow and can help to differentiate vascular from non-vascular structures such as nerves, lymph nodes, and bursae.

The use of color doppler is based on measurements of movement. Specifically in this case, it was used to measure the movement of blood in vessels, which is processed as a color flow display. A common misconception is that red is arterial flow, and blue is venous flow, however this is not necessarily always the case. In fact, by default, red is simply indicative of flow moving towards the probe, and blue is indicative of flow moving away from the probe. This is important to note as the doppler ultrasound beam must be aligned to the direction of flow (angle of insonation), or more parallel to the flow (typically <60 degrees), as opposed to perpendicular to the flow. The figure below illustrates this concept.

Effect of transducer position (angle of insonation) on color doppler signal interpretation. Image courtesy of Dr. Mike Mallin.

Also keep in mind your scale when using color doppler. The higher the flow state (e.g. an artery), the higher your scale should be. If the scale is set too low (as is the case in these clips), you will see more artifact including aliasing, which is an artifact where the color signal “folds over” and falsely appears to be reversing flow. In general when using color and pulsed wave doppler, the scale should be optimized to minimize aliasing, and the gain should be turned up until color artifact is seen, then turned down just below that point.

doppler_prox_brachail_gif

Use of a low scale (4 cm/s in this case) on a high-flow vessel can produce an aliasing artifact, falsely appearing as reversal of flow

DISPOSITION AND CASE CONCLUSION

Given the patient’s symptoms and point-of-care ultrasound findings of a non-compressible right brachial artery with visible thrombus, a heparin bolus and infusion were initiated. Vascular surgery was emergently consulted, and the patient was taken for emergent right brachial artery thrombectomy with removal of a large subacute thrombus with restoration of normal perfusion in her arm. She was discharged home the next day on enoxaparin as a bridge back to warfarin.

Point-of-care ultrasound for evaluation of arterial thrombus is an advanced skill, and there is limited evidence on its use by emergency physicians. If there is a concern for arterial thromboembolism in a patient, a vascular surgeon should be consulted given the emergent nature of the process. Revascularization of an ischemic limb within 12 hours has an amputation rate of 6%, and rises to 20% at 24 hours [1]. Given the need for timely diagnosis, point-of-care ultrasonography can be a beneficial skill for the emergency physican to have, as it can potentially shorten both time-to-diagnosis and time-to-embolectomy.

TAKE-HOME POINTS

  1. While there is limited evidence on the use of point-of-care ultrasound by emergency physicians for the detection of acute limb ischemia, classic positive findings of arterial thrombus can decrease time-to-definitive care.
  2. Sonographic findings of arterial thrombo-embolic occlusion [2]:
    • Non-compressive artery
    • Lack of or altered color doppler flow in artery
    • Intraluminal echogenic material in artery
  3. Optimize your probe position when using color doppler to visualize flow within a vessel (i.e. more parallel to direction of flow), and adjust your scale to suit the flow conditions (i.e. higher flow = higher scale, to optimize your image and reduce aliasing).
  4. If your images will not be readily available for the surgeon, consider marking the patient to demonstrate the location of the clot:

clotimage

REFERENCES

  1. Cook T, Nolting L, Barr C, Hunt P. Diagnostic ultrasonography for peripheral vascular emergencies. Crit Care Clin 2014;30(2):185-206. PMID: 24606773
  2. Rolston DM, Saul T, Wong T, Lewiss RE. Bedside Ultrasound Diagnosis of Acute Embolic Femoral Artery Occlusion. J Emerg Med. 2013;45(6):897-900. PMID: 23988137

ALiEM Copyedit

November 13, 2014

Copyeditor notes:
Great post on a case of nontraumatic arterial limb ischemia (ALI), diagnosed by bedside ultrasonography. I removed a few periods and commas which were extraneous. I also reorganized how the exam findings were listed to distinguish between left and right arm findings. Changed medication names to generic rather than brand names. Some questions and suggestions:

  1. You may be over-reaching the scope of a the main teaching point of using ultrasound to detect an arterial thrombus. Would remove some of the take-home points and any mention of content which reviews the pathophysiology/ basic issues on ALI. These points seem to detract from your main message.
    • FYI in a journal review article, I think your writeup would be perfectly fine to include the broader scope of talking about ALI. In this series, we were aiming for a clean, short, “simple” message on how ultrasound can be done to save time and improve patient care — more on the mechanics and technique.
  2. Videos: Can you crop out as much text (especially the date and any ultrasound company logos) from the videos? FYI for all blog posts, I’d remove any mention of date or time of day (e.g. afternoon, night) to avoid ANY risk of HIPAA issues.
  3. Image: Is the diagram from Cook et al copyrighted? Do you have permission to use? Would draw your own original, if not.
  4. Image of arm with “clot” text: Nice inclusion to mark location of clot.
  5. Take home point #1: Did you mean “In retrospect” instead of “on repeat exam”?
  6. Take home point #3 and #7 seem similar. Basically it sounds like even though you think you see a peripheral arterial thrombus, a second study such as a formal ultrasound or CT angiogram may be indicated to confirm the diagnosis before an intervention is made. Can you combine this teaching point somehow?
  7. I like take-home point #2. Emphasizes the importance of timeliness in this diagnosis.
  8. Can you accompany each ultrasound video with a screen shot of the most important view and label it? See other #US4TW posts. Labeling will be key to help readers understand what you are talking about.
  9. Sounds like the pulse wave doppler wasn’t used. You may consider removing mention of this to avoid confusion. I defer that to you, your prepub critique reviewer, and expert peer reviewer.
  10. A bit lost on the 5 points under Point of Care Ultrasound. I’m hoping some labelled diagrams might help (point #8).

Great save using ultrasound!

[AUTHOR RESPONSE: Thanks Michelle.
I have made the text improvements, and will wrestle with adding the .GIF’s this weekend and cleaning up the explanations of the images. I will create my own diagram to replace the one from Cook et. al. — Rob]

Michelle Lin, MD, ALiEM Editor in Chief; Associate Professor of Emergency Medicine, UC San Francisco

 

ALiEM Copyedit

November 14, 2014

Hi Dr Bryant,

Great case and another new tool I will be utilizing. I do a have a few comments on the post:

  1. There is a good amount of time dedicated to the use of Doppler in your post, but it was not needed for this case. Can you comment on the utility of using with/without Doppler.
  2. Can you comment on utilization of this technique in the lower extremity? Key locations to scan or any differences in technique?
  3. Agree with Michelle on cropping the videos/GIF. Feel free to email me if you are having difficulty in doing so. Also ideally their resolution should be the same so their size is handled similarly in WordPress.
  4. I like the “CLOT” drawing on a the arm.

Otherwise, I made a few subtle modifications to the Case Presentation for readability. A few tweaks to ‘slang’ terms as well (angio)

Overall very informative, good read, emphasizes the important points.

[AUTHOR RESPONSE: Thanks Sameed,
I will add the details about evaluating lower extremities and will add the .GIF files with doppler this weekend. The doppler views, and the trouble shooting of those views should be useful to other US neophytes. Even in the setting of seeing clot within a vessel, doppler evaluation provides secondary confirmation of vessel occlusion that would justify taking the patient to the OR based on our US exam.]

Sameed Shaikh, MD, ALiEM-CORD Fellow, Emergency Medicine Resident, Wayne State School of Medicine

 

Expert Peer Review

November 23, 2014

Great case Rob!

Here are my thoughts:

  1. I like how you emphasize the importance of angle of insonation when using doppler ultrasound. Your figure is good, but could you add a little “) <60″ to denote exactly which angle you’re talking about?
  2. I would emphasize that while an angle of insonation.
  3. While by convention red is towards the probe, this setting can be changed in the machine, and you could just point out the scale in your figure on aliasing which shows red at the top, meaning towards, and blue at the bottom, meaning away from the probe.
  4. It’s unclear exactly what is meant by “scale” when talking about color doppler. I think you mean Nyquist limit, which would normally be set around 60m/s for higher velocity studies and about half that for lower flow venous studies. While the Nyquist limit will control the velocity at which aliasing occures, in this case we’re more interested in optimizing the gain, which is the sensitivity to flow in general. Rather than go into this in depth, I would simply give the tip that when using color doppler, the gain should be turned up until spontaneous color artifact occurs, then turned down just below that point.
  5. Lastly, I recommend a link that will play an audio recording of Rob reading this blog post so that we can hear his dulcet Kiwi-tones while learning about this excellent use of ultrasound.
Jimmy Fair, MD, Ultrasound Fellow, Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine

 

Expert Peer Review

November 26, 2014

Rob,
Great catch and nice work on the write-up Rob. Generally, I think this is an exceptional use of ultrasound in the emergency department. I have personally seen several similar presentations, although in the femoral or common femoral artery. An additional take home point I would make is that you can perform this exam at the bedside in a stable patient before they go to the CT scanner. While I understand your concern for an aortic catastrophe, I imagine an acute thromboembolism diagnosis by ultrasound may have saved some time to consultation, or at least allowed you to get a more directed CT scan to include the upper arm.

A couple of specific comments:

  1. Your description of the direction of flow is important. Red does NOT mean arterial and blue venous. You explain that well. However, the direction of flow can be switched on most machines too. So while the standard is that red = towards the probe and blue = away (BART: Blue Away Red Towards). That can change too. The easiest way to tell for sure is to look at the color legend on the ultrasound screen. Your “Aliasing” image for example has the red on top and the blue on bottom. This means the red is towards the probe and the blue is away. This can be flipped on almost all machines out there. Usually not important, and not necessary for diagnosis in this case.
  2. Regarding the angle of insonation: I have another image that might suit your needs better and shows how the Doppler waveform changes with probe angulation. Here you can see the actual Doppler shift, represented by velocity, changes with the angle of insonation the probe makes with the moving blood cells.
  3. This statement is a little misleading: “In general when using color doppler, the scale should be turned up until spontaneous color artifact occurs, then turned down just below that point.” When adjusting color and pulsed wave doppler the SCALE (cm/s) should be adjusted so that aliasing is minimized (Except in the cardiac exam where aliasing is expected with regurgitant lesions). Conversely, the color “GAIN” should be adjusted by turning up the gain until color artifact is seen (Noted by little color speckles where there is no flow) and then turning the gain down just so that artifact disappears. On most machines the gain button that makes the image brighter or darker turns into a color gain when you put the machine into the color setting. So typically, you can just adjust the gain to increase the brightness and sensitivity of the color settings.
  4. Take home point #2, bullet 2: Sometimes you can see color flow around the thrombus. In this case, the velocity is often increased causing aliasing you would not see in the normal portion of the artery. I have attached an image. Recommend changing this bullet to “Lack of or altered color doppler flow in the artery.
  5. Take home point #4. See above for exceptions to direction of flow. Although an interesting aspect of this case, I do not believe this is important enough in the diagnosis of the thromboembolism to be one of your take home points. I would recommend removing.

Great work Rob, thank you for the opportunity to review this excellent USFTW.

[AUTHOR RESPONSE: Thanks Mike for your expert peer review! I’ve made the suggested changes to the post which helps clarify things.

I also do think your image better illustrates the point we were trying to get across. Can we use yours in the post? Is there a reference that we can put next to it?

Thank you again for being a part of the US4TW case series!

-Jeff]

Mike Mallin, MD, Assistant Professor of Surgery, Director of Emergency Ultrasound, Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Co-Creator: Ultrasound Podcast

 

Author information

Rob Bryant MD

Rob Bryant MD

Utah Emergency Physicians

Adjunct Assistant Clinical Professor of Emergency Medicine

Division of Emergency Medicine, Department of Surgery

University of Utah School of Medicine

The post US4TW Case: 74F with Right Arm Tingling appeared first on ALiEM.

Eve Purdy, author of Manu et Corde blog: How I Work Smarter

How I Work Smarter LogoEve Purdy (@Purdy_Eve) is one of those rising stars in medical education, who “leads from the middle” in her role as a senior medical student at Queen’s University. She is already quite involved as a blogger at Manu et Corde, a Medical Student Editor at Boring EM, and as a part of the ALiEM Book Club team. I, along with many others, are eager to see what Eve has in store for the world of medical education in her early promising superstar career. Eve was tagged by Dr. Teresa Chan in a previous How I Work Smarter post and was kind enough to share her tips for, as Eve states, “TRYING to work smarter”.

Purdy

 

  • Name: Eve Purdy
  • Location: Kingston, Ontario
  • Current job: 4th Year Medical Student, Queen’s University
  • One word that best describes how you work: Smiling
  • Current mobile device: iPhone 4
  • Current computer: MacBook Pro (2010)

What’s your office workspace setup like?

As a student I have two jobs:

  1. Satisfying curricular requirements and learning medicine
  2. Working on side projects that fill up my autonomy gas tank

My workspace needs to help me do both. I always carry my office with me in this bag:

Purdy Office

 

It carries everything I need to make this workspace:

 

Purdy Work Space

 

I’ve always got my iPad and iPhone (for quick FOAM bites and mastery learning through questions when I have the chance) and my notebook in case I have the opportunity to work on one of my side projects. I always have powercords for the devices and headphones to stream good beats. My dream is to have a stand up workspace at home!!!

What’s your best time-saving tip in the office or home?

In addition to scheduling in study time- literally blocking it off in the calendar, I also always try to make things count twice (or more). This means a couple of things:

  • If I need to do something for curricular requirements, I will try to integrate it into a side project (i.e. write a blog post) on the same topic.
  • I also try to study with friends so that learning is a social experience. We learn together and have many, many laughs.

What’s your best time-saving tip regarding email management?

I am bad at this. I’ve adopted the inbox zero approach after Michelle Lin’s description of her email management. It seems to be working but I have a long way to go. Amalgamate your inboxes.

What’s your best time-saving tip in the ED?

I am definitely not in the business of saving time, yet. But for learners I would recommend knowing how to find information efficiently. I have one favourite app (Palm EM) and I know where and how to search it well. It is mostly a one-stop shop (except for med dosing). My other tip would be for procedures, while you are in the storage room work through your procedure in your head then grab ALL the necessary equipment so that you are not back and forth a bunch of times. Keep a list (I use paper) of tasks you need to complete or check up on. Don’t lose the list.

ED charting: Macros or no macros?

I don’t use macros. As a learner, I find that writing the note is an important part of processing the presentation and problem at hand. My note can provide a window into my brain and clinical reasoning for supervisors I work with too!

What’s the best advice you’ve ever received about work, life, or being efficient?

Life: Growing up my mom put a quote on our fridge. I looked at the phrase “Happiness is a Choice” every day for 18 years and now I know it to be true. In every interaction, every job, every task and every relationship I can choose to be happy; life is wonderful for it.

Work/School: I learned how to read efficiently to improve retrieval for diagnostic reasoning in the Clinical Problem Solving MOOC run through UCSF/Coursera. The course is live again in January, I would highly encourage medical students to invest the time in this course.

Who would you love for us to track down to answer these same questions?

  1. Grace Leo
  2. Heather Murray
  3. Chris Bond

Author information

Michelle Lin, MD

ALiEM Editor-in-Chief

Editorial Board Member, Annals of Emergency Medicine

UCSF Academy Endowed Chair for EM Education

UCSF Associate Professor of Emergency Medicine

San Francisco General Hospital

The post Eve Purdy, author of Manu et Corde blog: How I Work Smarter appeared first on ALiEM.

Future of ALiEM: Need YOUR input

The 2014 year has been amazing. As 2015 approaches, the ALiEM team has gotten quite reflective and thankful for the past amazing 12 months. We can track many things through Google Analytics, but there’s nothing like hearing from our readership directly to help us shape the upcoming 12 months. There are many innovative plans in the works, and your input would be incredibly helpful to help us tailor our priorities to what YOU want. We are a volunteer organization, made up of passionate, early-adopting educators, who are asking for nothing more than YOUR valuable input. Please donate 1 minute of your time to fill out this quick survey. Once you submit your feedback, you can see what everyone else said. The beautiful infographic results page by Google Forms is worth seeing too. Thanks!

Use this Google Form link, if you can not access this embedded form.

Author information

Michelle Lin, MD

ALiEM Editor-in-Chief

Editorial Board Member, Annals of Emergency Medicine

UCSF Academy Endowed Chair for EM Education

UCSF Associate Professor of Emergency Medicine

San Francisco General Hospital

The post Future of ALiEM: Need YOUR input appeared first on ALiEM.