August Q-tips

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    August Q-tips

    • Patients with lower quadrant pain should typically have gonadal examinations. There are relative exceptions–such as virginal women without history of pelvic examinations or IBD patients with symptoms very typical of previous IBD flairs–but gonadal examinations should still be considered in these patients. Ideally, these examinations should take place before CT imaging.

     

    • Patients with previous tracheostomies are likely to be difficult intubations. Tracheostomy history may be an indication of distorted anatomy or a previously failed endotracheal intubation.  Awake intubation, preparation of a fiberoptic intubation, or preparation for repeat surgical airway should be considered ahead of time.

     

    • When bagging a cardiac arrest patient, use “squeeze release release release release release” to shoot for ~8 breaths per minute.

     

    • Use of librium in alcoholics continues to be controversial and management of these patients is plagued by significant practice variability. One approach stipulates that all alcoholics who are not discharged/allowed to walk out as soon as they are sober enough to do so (e.g. are to be seen by psychiatry) should get 50-100 mg librium and reassessed specifically for withdrawal symptoms every 2 hours; if hyper-dynamic but well should receive 100-200 mg librium. The purpose is to prevent a medicine admission for withdrawal, which serves nobody’s interests. This practice is not to be confused with discharging patients with a librium prescription, which is less likely to be effective (though there is still a role for outpatient librium in selected motivated patients).

     

    • Although pelvic exams are uncomfortable and usually non-contributory, it is difficult to defend not performing a pelvic exam in the relevant context; if it turns out the pelvic exam would have been contributory but it was omitted, that is an important error. The threshold to perform a pelvic exam should therefore be low.

     

    • Set patient expectations low with regard to wait times for tests, consultation, admission. Consider not having ENT scope patients with allergic reaction; there is much practice variation on this point.

     

    • Don’t forget to introduce yourself to patients.

     

    • Urine beta is a fallible test, repeat or send serum quantitative beta when negative result is discordant with clinical circumstance.
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