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Wikipedian

I’m officially a Wikipedian.  I was searching for an article on the PERC Rule, and Wikipedia didn’t have one – so I was forced to write it. 

I really find clinical decision tools helpful because it means I’m practicing evidence-based medicine.  If I document PERC Rule negative, It’s like I’ve got a mountain of evidence backing me up.   If you’re interested in a handy mnemonic for the PERC Rule, see this post.

http://en.wikipedia.org/wiki/Pulmonary_Embolism_Rule-out_Criteria

New Plates

Here’s Devin installing my new plates!

ED Mnemonics

Here are a few mnemonics I picked up that helped me out…

HAD CLOTS: PERC Rule – Risk factors for PE
Hormone use
Age >50
DVT/PE History
Coughing Blood
Leg Swelling – Unilateral
O2 Sat < 95%
Tachycardia
Surgery/Trauma History – Recent

AMPLE: Important history items in trauma patients
Allergies
Medications
Past Medical/Surgical History
Last Meal/Last Menstrual Period
Events/EMS/Environment

PHAILS: Toxins that cannot be decontaminated with charcoal
Pesticides
Hydrocarbons
Acid/Alkali
Iron
Lithium
Solvents

DUMB BELSS: Cholinergic Toxidrome
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Emesis
Lacrimation
Salivation
Sweating

ME DIE: Differentials for Osmolar Gap
Methanol
Ethanol
Diuretics (Mannitol, Sorbitol)
Isopropanol
Ethylene Glycol

MUDPILES: Differentials for Anion Gap Acidosis
Methanol
Uremia
DKA
Paraldehyde
INH, Iron
Lactate
Ethanol, Ethylene Glycol
Salicylates, Starvation, Solvents

AEIOU: Indications for dialysis
Acidemia
Electrolytes (Potassium)
Ingestion (Drugs)
Overload (Fluid)
Uremia

I STUMBLED: Toxins that can be removed by hemodialysis
Isopropanol
Salicylates
Theophylline
Uremia
Methanol
Barbiturates
Lithium
Ethylene Glycol
Depakote

AEIOU TIPS: Differentials for Altered Mental Status
Alcohol
Endocrine
Insulin
Opiates
Uremia
Toxins, Trauma, Tumor
Infection
Psychosis
Stroke, Seizure, Shock

Living Connected

I’m writing this post from my iPhone using the WordPress app. It’s nice to be more connected. I’m also using a cool FTP picture uploader to send photos from the iPhone to my gallery. Look for more up-to-the-minute updates and photos from wherever I am!

Here’s a photo of us at Disneyland yesterday. There’s more in the gallery!

The character of the Emergency Physician

I usually don’t distribute stuff forwarded to me in an email, but this one was pretty cool.  I kind of wish I had it when I was writing my personal statement for ERAS and doing interviews.  I think it really nails the character of the Emergency Physician. 

Read more »

Recycling the Lifedrive

After getting the iPhone, my wife and I had some toys that went into obselescence.  One of them was my old Palm Lifedrive.  Although the touchscreen was getting a little worn out, it still has a lot of life in it.  It has a decent battery life, a bright 480X320 screen just like the iPhone, wifi, bluetooth, and a 4GB hard drive. 

I ran across an interesting program – TCPMP.  It has since been discontinued, but here’s a link to the Palm version: TCPMP

I loaded up the Palm with videos for my son, and bought a cheap $4 set of headphones for him.  I even have the car charger, so he can watch videos on long car rides. 

The only downside was that it can’t handle some files with high bitrates (above about 1000k/s).  I use Avidemux to transcode the files and resize them to the Palm’s native 480X320 resolution.

Medical Latin

 Some useful and poignant phrases with translations.  Great for your next tattoo, or when prescribing medical marijuana “ql“. If nothing else, you can tell your partner you want to do it “more ferarum”.

primum non nocere
“first, to not harm”
A medical precept. Often falsely attributed to the Hippocratic Oath, though its true source is probably a paraphrase from Hippocrates’ Epidemics, where he wrote, “Declare the past, diagnose the present, foretell the future; practice these acts. As to diseases, make a habit of two things: to help, or at least to do no harm.”  
 
cura te ipsum
“take care of your own self”
An exhortation to physicians, or experts in general, to deal with their own problems before addressing those of others. 

lege artis
“according to the law of the art”
Describes something genuine, true, real, tested, proven, not assumed, not placebo. The ‘art’ referred to in the phrase is medicine.   

locus minoris resistentiae
“place of less resistance”
A medical term to describe a location on or in a body that offers little resistance to infection, damage, or injury. For example, a weakened place that tends to be reinjured.  

ad pondus omnium (ad pond om)
“to the weight of all things” More loosely, “considering everything’s weight”.
The abbreviation was historically used by physicians and others to signify that the last prescribed ingredient is to weigh as much as all of the previously mentioned ones. 

quantum sufficit (qs)
“as much as is enough”
Medical shorthand for “as much as needed” or “as much as will suffice”.

quantum libet (ql)
“as much as pleases”
Medical shorthand for “as much as you wish”. 

coitus more ferarum
“congress in the way of beasts”
A medical euphemism for the doggy-style sexual position.

COMLEX II Percentile Table

The three-digit COMLEX score is often difficult to interpret.  This table converts your score to a percentile so you can gauge your performance against that of your peers. This table is based upon the 1995 to present three-digit score with a  mean of 500 and a standard deviation of 83.  Passing score is 400. Read more »

Camaro time bomb

My wife’s Camaro just went into self-destruct mode.  It seems like all at once, everything broke.  The thing is 8 years old but it has low miles, and we take good care of it.  The windshield cracked, the brakes warped, the differential’s making noise, the speakers blew, and the battery gave up the ghost. 

The most challenging repair was the speakers.  She has the premium Monsoon sound system, and it has some crazy components.  The front 6½” speakers have separate inputs for the woofer and tweeter, with the crossover in the head unit.  My first thought was to simply frankenstein together some aftermarket speakers by bypassing the crossover in the speaker, but I was horribly wrong.  It turns out that they used 2Ω woofers and 4Ω tweeters!  Most aftermarket speakers have 4Ω voice coils, which would mean crappy bass response.  I looked up the price of the factory replacement speakers, and they were $90 EACH! 

A quick internet search found that many people had suffered this situation and found a solution with Infinity’s Kappa speakers, which have 2Ω voice coils.  I picked up a pair of 60.9cs component speakers, and wired ‘em up.  The main dilemma came when I read a little on impedence matching.  It turns out that most amps can easily drive speakers with higher impedence than rated, but using a lower impedence speaker can damage your amp.  I was worried that the 2Ω tweeters would cause problems.  The increased power would also mean overwhelming highs.  You could solve this by going to your local RadioShack and wiring a couple 1Ω – 10 watt resistors in series with the tweeter, but I chose to just hook up the included crossover to the tweeter and use the -6dB button to reduce the output (RadioShack was out of the resistors I needed). 

The Kappas sound awesome, and they’re loud enough to drown out the horrible noise coming from the rear end!  Let’s just hope nothing else breaks!

Mistakes I made in the match…

Just found out I didn’t match in the NMS/AOA match.  Thought I would blog a little about my problems. 

When you start applying, make note of individual program deadlines.  Some programs may have ridiculously early deadlines – like October.  My school really procrastinated in uploading my MSPE/Dean’s Letter, and I just assumed that they would upload it before any program deadlines, so I took my time working on my personal statement, and ended up submitting my ERAS application too late for some programs. 

Submit your ERAS app when it first opens!  One of the things I learned long after it was too late was that you can certify your application and submit it SEPERATELY from your documents.  That means that you don’t have to have all your LORs, MSPE, and personal statement completed before you submit your application.

Set up audition rotations late enough that you are experienced, but still before the program creates their rank order lists.  I set up an audition rotation at my first choice residency as the first rotation of my fourth year.  Turns out I didn’t make a very good impression because I was still a little green.  Looking back, my critical thinking skills improved dramatically during my fourth year, and I really looked good in later audition rotations.  Rotating later (even after an interview) also lets them have you fresh in their memory while they are creating their rank order lists.  Of course, a rotation can hurt you just as well as help you. 

Keep in contact with programs throughout the process.  Just try to avoid looking like a suck-up, or doing it so often that you become annoying.  If you are competitive and don’t rotate there, they may invite you for a visit close to match time, or it may just help to solidify your image of dedication.  Don’t get discouraged if you don’t hear back from a program – some programs have a policy of not contacting applicants outside of interviews. 

I hope this helps someone… please learn from my mistakes…