Clinical Reasoning (1st draft)

The goal here is to start teaching clinical reasoning on day 1 of medical school. Though the students don't yet have the medical knowledge to apply, I bet they can learn the process. 01: An Overview The first video gives an overview of the process. There is a lot in here that will be unpacked … Continue reading Clinical Reasoning (1st draft) →

Discharge Instructions

The October edition of EM-RAP had a great section on how to write good discharge instructions. This is not the pre-printed stuff that comes with the EMR but instructions written specifically for each patient. I modified my DCI (discharge instruction macro) to make those points more obvious. You have been diagnosed with ***, this is … Continue reading Discharge Instructions →

Brief Resolved Unexplained Events (BRUE)

ALTE has been deprecated and replaced with BRUE. Apparent Life-Threatening Events scared parents and led physicians to unnecessary testing. The American Academy of Pediatrics has issued the following guideline. BRUE ==== STEP 1: Meets DEFINITION of BRUE - BRIEF: less than 1 minute episode - RESOLVED: back to baseline/normal - UNEXPLAINED: no other etiology (no URI, … Continue reading Brief Resolved Unexplained Events (BRUE) →

HEART Score

Used to risk stratify patients for further cardiac workup in the ER according to risk of major adverse cardiac events (MACE). History 2: highly suspicious 1: moderately suspicious 0: slightly or non-suspicious ECG 2: significant ST-depression 1: non-specific repolarization 0: normal Age 2: > 65 years old 1: 45-65 years old 0: < 45 years … Continue reading HEART Score →

Essentialism

For me, the most important image from Greg McKeown's book "Essentialism" is a circle with "energy" at its center. In one circle, energy is expended in several directions. No net progress is made when adding all these vectors. In a second circle, all the effort vectors are aligned. Adding these vectors takes you somewhere. Your … Continue reading Essentialism →

Critical Thinking in the ED

Shock

Remember that Oxygen Delivery is composed of two parts: What is Shock? [Oxygen Delivery] = [Oxygen Content] [Cardiac Output] In the first video, let's go over problems with that second part: cardiac output. How can cardiac output go wrong? All of these can lead to decreased cardiac output. Cardiac: problems with the PUMP. The heart … Continue reading Shock →

GTD Weekly Review

I rarely do the the weekly review in the GTD process, but can see its importance to get a handle on the upcoming week. Here's a process I heard on David Allen's podcast. Get Clear Collect Collect Loose Paper and Materials. Find all papers, receipts and other things and put them all in one place. … Continue reading GTD Weekly Review →

Mental Status Exam

For the inevitable moment when the medical record eats all my macros, I'm backing them up here. Also, if anyone finds them useful, feel free to steal them. I stole them from elsewhere. MENTAL STATUS EXAM: - Appearance: ***well-groomed, alert, co-operative - Mood: ***pt states they feel depressed - Affect: ***pt appears depressed, ***congruent with … Continue reading Mental Status Exam →

RMC: Clinical Bridge – Can’t Miss Diagnoses

RMC Clin Bridge Can't Miss Dx Handout 2016 University of Colorado's Intern Survival Guide