Monthly Archives: April 2012

Daily Cup – The Set-up

Have I mentioned that coffee is an key player in my life as an EP?  In theory making coffee is a simple process that has only a few essential steps; yet it’s amazing how many ways you can make coffee badly, (and there is no end to the number of companies willing to sell you their way of making it badly.

Another major problem is cost.  It’s easy to spend $10 a day on good coffee which can add up.  Now I have no problem paying $3.50 for a good hit of Counter Culture espresso from time to time, but I really don’t feel compelled to dish out $20,000 for my own La Marzocco espresso machine (until I can afford to hire the barista to go with it of course).  So for around $120 I think I have found the sweet spot for home coffee production that will satisfy the needs of all the serious coffee drinkers and sleep deprived EPs out everywhere.

Step one.  The grind.  Anyone who makes good coffee will tell you the grind is key.  Screw it up with a cheap electric blade grinder or buy the coffee ground and, well, you’re on your own.  Enter the burr grinder that doesn’t cost a lot and takes the ritual of coffee making old school.  The Hario Skerton Hand Coffee Grinder – Ceramic Burr Coffee Mill.

This hand grinder does require a bit of time and elbow grease, but not excessively so.  I use the time grinding to review the dosing of my important RSI medications or the entry criteria for the Canadian C-Spine rule.

Step two. The brew.  I’m a fan of the French press.  In general they make a rich, strong brew with a taste as close to espresso as you can get without the steam.

The drawbacks are a lot of them are made of glass and don’t travel so well, and most of the plungers that filter the coffee leave a substantial amount of grounds in the bottom of your glass.

Like good wine, I don’t mind a bit of silt at the bottom of my glass, in fact I kind of enjoy it, but when I start spitting out coffee grounds like its tobacco there’s a problem.

My Espro at home with some new Stumptown coffee beans.

The Espro Press 8 Oz Stainless Steel Coffee Brewer.  Light, durable, with an insulated container to keep the coffee hot and a filter system that makes clean, grounds-free coffee.  Both of these items can be found on Amazon (I’ve provided the links).

The only downside I can see for this system is that it requires a little bit of time.  From grind to pour is about 10-15 minutes.  But that’s nothing if you consider the time it takes going out for coffee.  Once you realize that you will save a fortune in store bought coffee drinks, and be able to make it how you like every time, you may even begin to enjoy the ritual of the home brewed coffee before a shift.

ACS – More Note Cards in Verse

Surprisingly, EM Notecards in verse are a huge success (or at least they are a novelty of sorts in the EM blogosphere). Occasionally on sign-out after a long shift I will threaten the residents with having to present in Haiku if they don’t keep their sign out on point, so there is a precedent. I will say that having to distill a medical article into four lines of verse is not as hard as you might think, which makes me more convinced than ever that professional medical writing is too wordy, and just bad plain bad.

One of the most common problems is the mistaken belief that more words make you sound smarter.  How many times have you read a journal abstract and realized that the article could have been summarized clearly in one sentence (instead of the long run-on paragraph filled with medical techno-babble you were unfortunately subjected to).

I know plenty of medical literature citing patient hand-offs as the source of medical errors, but none of these, to my knowledge, have looked at the length or format of the presentation being an issue.  In my experience a dull, disorganized narrative with the important points buried in irrelevant prose makes the mind go numb.

So this note card in verse is inspired by a study that was reviewed by Dr. Radecki, over at Emergency Medicine Literature of Note.  I really love this site.  For a busy EP, having an online source that curates and critiques current articles rather than slogging through the general detritus is a good thing.  In addition he writes well, and can sum up the essence of a study in a few hundred words.  So if for some bizarre reason you want more cogent reviews of the current literature  than four lines of iambic pentameter, I encourage you to add EM Lit of Note to your blog feed.

Tools to Live By – One Minute Ultrasound

At the dawn of the golden age of the peripheral brain, access to information seems limitless.  Need to get a stain out of a tablecloth?  No problem, Google has 500 solutions.  Your dog’s breath smells? There’s likely a Youtube video for that.  But when it comes to the busy EP, the real information challenge is not finding something online when you’re home on the couch half-watching TV, and getting in trouble with your wife by commenting on how stupid Gray’s Anatomy really is, but finding focused, readily accessible information for the busy ED context in which it’s required. Type FAST exam into Google and it still doesn’t know if you need an overview of the current literature or a quick video on what Morrison’s space is supposed to look like.

One solution is dedicated apps on your smartphone that bundle discrete information into a coherent whole.  Unfortunately some apps are just bad and even worse than just a simple Google search, some information is just not amenable to an app, and even good apps can become cumbersome if you have hundreds on your phone you have to sift through.

Ultrasound tutorials were a natural early choice for online Emergency Medicine education and readily take advantage of video, text and audio formats. But the same problem of context still exists: is that one hour lecture on ultrasound in pregnancy really appropriate when all you want to do is review definitive signs of early pregnancy before going in to see your patient?

That’s where the new One Minute Ultrasound app finds its niche.  Mike and Matt at Ultrasound have created a collection of short video tutorials on many of the bread and butter ultrasound exams performed by EPs daily.  This is great for the resident doing ultrasound, but still perfecting their skills, or for the older EP who wants get more comfortable with ultrasound in their daily practice.  Its also a great quick review for EPs comfortable with ultrasound but looking for a quick refresher.

The app itself has a couple of bugs, but overall it meets the major requirements of being fast and easy to access, and it’s concise, and high yield.  Pull it out of your pocket on the subway when you have a minute or two, or before going in to see a patient for a rapid review.  A great first pass, that will no doubt get better.  Best of all, since it is free and open access there is no downside to giving it a try.  Thanks to the guys from Ultrasound Podcast for adding to our toolbox.


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