EM Reflections – December 2015

Thanks to Dr Natasha DeSousa for her M&Ms presentation today.

Thanks to those who attended M&Ms. For those of you who missed it, here are the top tips:

1. When burring or curetting a corneal FB from an eye, remember there is always a risk of a scar and too much or too deep anteriorly means a scar in the visual field. Be careful.

Watch this video on corneal FB removal:

2. Transferring unstable patients within a hospital (e.g ED to CT, ED to Cath Lab etc) is associated with risk and requires careful consideration. 

See this article on Medscape (Crit Care. 2015;19(214) ) that discusses the risks involved during intrahospital transfers and proposes a checklist that can be used to ensure preparedness.  See the form proposed below (or here : http://www.ncbi.nlm.nih.gov/pubmed/25947327 )

Checklist_for_Intra-Hospital_Transport_of_Critically_Ill Checklist_for_Intra-Hospital_Transport_of_Critically_Ill 2

3. Personality traits can impact on the clinical interview. When considering a differential diagnosis, ask yourself: “If this were a different patient with the same presenting symptoms and signs, what diagnoses would I be considering?” Some physicians endorse having a list of at least three possibly life-threatening conditions on one’s radar for each presentation. Try it – this is a great way to mitigate the potentially life-threatening impact of fundamental attribution error.

See last month’s report for a full list of clinical decision making biases

4. What is fundamental attribution error?  This is the tendency for people to place an undue emphasis on personality to explain someone else’s behavior in a given situation rather than considering other potential factors.  For instance, “he is wailing out in pain because he has an opiate addiction problem” rather than “he is wailing out in pain because his bowel has just perforated.”

5. Management of Acute pain in the Emergency Department is a priority. See the SJRHEM pain control resource page.


6. The management of spontaneous pneumothorax remains controversial. There are a number of international guidelines e.g British Thoracic SocietyConsider consulting Thoracic surgery when a lung has failed to fully re-inflate after 72 hours of standard treatment.

7. Flexor tendon injuries need to see plastic surgery within 48 hours. Delaying the repair beyond this can result in poorer outcomes. See this article for a further information on flexor tendon injuries in the hand.


Open Orthop J. 2012; 6: 28–35.

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