Brought to you by Dr. Clay Smith and the folks at Vanderbilt and "Keeping up with EM" have come out with a really great app. Professional looking. I'm so jealous and inspired. Check it out!
Showing posts with label iPhone. Show all posts
Showing posts with label iPhone. Show all posts
New free app: Upshot
Brought to you by Dr. Clay Smith and the folks at Vanderbilt and "Keeping up with EM" have come out with a really great app. Professional looking. I'm so jealous and inspired. Check it out!
Modern EM: Case 3- Get your phones out
Sometimes on off-service morning table rounds, I like to close my tired eyes and focus my ears past the voice of the attending to hear the chorus of hundreds of pieces of paper flipping, shuffling, crinkling, and folding. It's one way to pass the time when surgeons debate over issues they don't already know the answers to. Another is to get your phone out, and help answer the questions with them.
Surgeon 1: She's breast feeding.
Surgeon 2: She's on zosyn. Can she breast feed? Is that safe?
S1: I don't know.
S3: Let's ask ID.
S1: We're not consulting ID for such a simple question.
S2: We'll curbside them.
S1: Ok, call them after rounds.
Me: The WHO says it's safe. (Micromedex)
S1: The staph culture is pan-sensitive.
S2: Give her augmentin.
S3: She has a PCN allergy - anaphylaxis.
S1: I don't give keflex to anaphylactic reactions to PCN.
S3: We can't use levaquin or bactrim because she's on coumadin especially because this will be long term.
S1: So what do we use?
S2: Let's ask ID.
S1: Ok, I'll call ID today.
Me: You can use doxycycline - no listed interactions with warfarin (Micromedex)
S1: Okay, but make sure you follow her INRs closely.
S1: Her ostomy output is through the roof.
S2: We can't keep up with it. Replacing her cc per cc with IV fluids.
S3: Maybe it's the daptomycin. Is dapto like erythro? Does it give you diarrhea?
S2: I don't know.
Me: 6-12% have diarrhea. (Micromedex)
S1: 6-12% days of the week I have diarrhea too. Keep her on the dapto.
EM residents are already valued on off-service rotations for their superhuman abilities to insert IVs and use ultrasound machines. Now, we can facilitate morning rounds with our smart phones too.
This is a 3-part guest series by Dr. Timothy Peck, who is launching his own blog at ModernEM.blogspot.com. Check it out!
YouTube: Now you can edit your videos online!
They really capture the primary features which you really need:
- Trimming the video (start and end)
- Rotating the video
- Manually changing the brightness and contrast
Sharing Paucis Verbis cards using Evernote app
Hot off the press!
As of yesterday, the comprehensive note-taking/organizer software Evernote has made a significant upgrade. Your mobile app version can now view shared notebooks.
Previously, you could share notecards or files with others using the "Shared Notebook" option. A major limitation was that you could only view files in these folders from the web application of Evernote -- not your desktop or your mobile device.
What does that mean now?
On your mobile device, such as your iPad or iPhone, you can now automatically get my Paucis Verbis (PV) cards every week. You don't have to manually download them. In fact, you might get an early preview of a PV card, since I usually make then 1-2 days prior to posting them on the blog. I keep them all in a Shared Notebook on Evernote.
How to link to my PV Shared Notebook:
1. Go to the public link:
http://www.evernote.com/pub/michelleclin/paucisverbis
2. In the upper right corner, click on the "Link to my Account" icon. This should create a PV folder in your list of "Linked Notebooks". This will require you to sign-in to Evernote, if you have not already.
3. After you update your Evernote app, your mobile device will now list "Shared notebook" as a new folder in your list of Notebooks (see image above). All of my PV cards should appear in this folder now.
Let me know if this doesn't work for you.
Trick of the Trade: Balloon animals in the ED
Back in July 2010, I wrote about using the Candleflame app to encourage pediatric patients to take deep breaths for a pulmonary exam. This app has also been useful in helping me roughly gauge the patient's peak flow.
Trick of the trade:
Balloonimals app
What kid doesn't love balloon animals?
You can download the Balloonimals "Lite" app on your iPhone for free. Have the child blow forcefully at the mouthpiece of your iPhone. This will inflate a balloon. Shaking your iPhone will magically convert the balloon into a cute T-Rex dinosaur. Touching the screen will animate the 3D dinosaur. Touching the air pump icon will pop the balloon.
Balloonimals Lite app [iTunes app store]
For an extra $1.99, you can download the full version, which includes different balloon animals.
Thanks to Dr. Susan Brim (UCSF-SFGH EM resident) for the tip! Disclosure: I do not have any affiliations with the company.
Blogger is mobile-format friendly!
I have been toying with ways to make my blog more mobile-viewing friendly. It turns out that Google and Blogger are way ahead of me. They just launched a beta version where blog-owners can make their site mobile-friendly with a simple click of a button!
Now if only I knew how to build an app for my Paucis Verbis cards... Mobile technology is taking over the world.
Find the closest ER = findER app
One of the cool things about having a blog is now people come to me with news. That's how I learned about Mass General's Emergency Medicine Network (EMNet) and their new mobile app called "findER". It makes clever use of the mobile phone's GPS capability and internet accessibility.
Here's the info that they provided:
The app launched for the iPhone in June 2010. Due to popular demand, we have recently introduced the app on Blackberry and Android platforms.
Through our studies, we have developed the most comprehensive, accurate emergency room (ER) database in the country. This free app uses that database of nearly 5,000 U.S. ERs to benefit individuals in an emergency situation. With one click, findER will get its users to the closest ER in the event of a health emergency. We think that the app is a must-have addition to anyone’s phone, especially when traveling with young ones and family members with chronic health problems during the upcoming summer months.
iPhone app: Webicina
What is Webicina?
It is an incredible one-stop shopping site for medical professionals and patients to join the Web 2.0 world. The site has and is constantly aggregating the most recent journal articles, blog posts, podcasts, and many more sources of media in 25 different specialties and in 17 languages.
They recently built an iPhone mobile app version which is pretty cool. It's so cool that it won the 2011 Medical Apps Award for Most Innovative App. Go to iTunes link to download this FREE iPhone app. Oh and I just read that the Android app will be available in June.
It's got a whole section on Emergency Medicine. In the app, you see that the EM section is broken down into:
- News and Information
- EM in the Blogosphere
- EM Podcasts and Interviews
- EM Community Sites, Facebook Groups
- Microblogging: Twitter and Friendfeed
- EM Wikis
- EM Videos, Animations, and Videocasts
- Mobile Applications
- Medical Search Engines
- Clinical Cases and Images in EM
- Slideshows about EM
First annual Medical Apps Awards: Vote now
The polls for the first annual Medical Apps Awards is now open. Voting closes April 21, 2011 @ 12:00 AM EST.
- General instructions (you can win various prizes)
- Go directly to the polls
1. Best Medical App for Healthcare Professionals
- MediBabble - a medical translation tool
- Doximity - a professional networking tool
- Medscape - comprehensive guide to drugs, interactions, diseases, & procedures
- Epocrates - comprehensive guide to drugs, interactions, identifying pills, & calculators
- DrChrono - the first EMR for the ipad
- iHealth BPM w/ cuff - the first medical app to take your blood pressure & keep track of it
- Asthma Maze - know which food additives & cosmetic ingredients can trigger an asthma attack
- Mayo Clinic Diabetes Type 2 Wellness Solutions - comprehensive guide to diabetes
- Free RX iCard - get discounts on prescription drugs at participating pharmacies, easy locater
- Calorie Tracker by Livestrong - keep track of your daily calories and weight loss progress
- Airstrip - monitor your patient's vitals, waveforms, labs, I/Os, meds, & allergies from home
- Webicina - a comprehensive online medical resource for both patients & healthcare folks
- Fooducate - scan any barcode in the grocery store to instantly see product health highlights
- PocketCPR w/cradle - real-time feedback so that anyone can do CPR correctly
- Google Translate - speak into your phone and it will speak out the translation
I thought I would mention this since Medibabble was created by recent graduates from the UCSF School of Medicine. It's a creative, well thought-out, free medical translation app. I had highlighted the app back in Feb 2011 and deserves to be on the list of impressive apps.
The downside of voting is that you are required to enter your email and snail-mail address in case you win the prize. Good luck to all the nominees!
I do not have any financial ties with any of these apps.
What's your perfect idea for a medical app?
The American Medical Association (AMA) is harnassing the innovative power of the people in its "AMA App Challenge". What do you think would be the perfect app for medical students, residents, and/or practicing physicians in their day-to-day life?
This challenge is the perfect opportunity for all those with great app ideas but are too busy (or lazy) to do the technical, legal, and business groundwork to make the idea a reality. The down side is that once you submit the idea, AMA has full proprietary ownership of it.
The submission is pretty short and sweet:
- Name and brief summary of app idea (500 characters)
- More detailed description - list benefits and features (2000 characters)
- Who the app idea will appeal to and why (2000 characters)
- How your app idea is innovative/different (2000 characters)
- How your app fits with the AMA's mission to promote art and science of medicine and the betterment of health (2000 characters)
- Your background and medical/tech expertise (2000 characters)
- 25%: Utility and appeal to target audience of physicians, residents/fellows, and/or medical students in their daily careers
- 25%: Fit with the AMA and its mission
- 20%: Innovativeness
- 20%: Suitability for app format
- 10%: Submitter's medical/technical background
Two Grand Prize winners will be selected and each will receive a $1,000 AMEX gift card, a $1,500 Apple Store gift card, and a trip for 2 to New Orleans (for the AMA meeting in November 2011). One Grand Prize winner will go to a medical student, resident, or fescsllow. The other Grand Prize winner will go to a practicing physician.
Up to 8 Runner-Up winners will each receive a $100 AMEX gift card.
Thanks to iMedicalApps for the heads up on this!
Search for PubMed articles on the go
This site allows users to perform basic PubMed search commands and to sort results based on "Free Full Text" and "Reviews" (see arrows).
Thanks to the folks at iMedicalApps for letting us know about the news.
Hot off the press: MediBabble app
One has stood out.
Medibabble is a real-time medical translation app and is now available for FREE. It was created by two innovative UCSF medical school graduates, Dr. Alex Blau and Dr. Brad Cohn. This app contains an extensive preset list of history questions and physical exam commands. When you click on a sentence, the app will translate and speak the sentence in one of 5 languages (Spanish, Cantonese, Mandarin, Russian, and Haitian Creole).
Download MediBabble (takes you to iTunes link)
Poll: Which handheld drug prescribing app do you use?
Well I finally took the leap and am primarily relying on my iPhone to look up medication doses, which I don't know off the top of my head. Gone are the days of purchasing Tarascon's pocket Pharmacopoeia every few years or so.
I still haven't settled on which I like more. Both are free. Both are available on multiple platforms, including iOS, Blackberry, and Android. Both have some unique features which I find useful.
Common strengths for both apps:
- They're free!
- Easy to find drug you are looking for. Epocrates has a Search screen as the home page. Micromedex has a Search screen and alphabetical list of medications as the home page.
- Dosing adjustments based on renal and hepatic function
- Adult and pediatric dosing recommendations
- Safety information with preganancy and lactation
Unique strengths of the apps:
Micromedex:
- Includes toxicology information for all the medications (what to do in case of an overdose)
- I have heard that this Thomson Reuters app has been more peer-reviewed and accepted as a very reliable resource, especially for pediatric dosing.
- Free from obvious advertisements (which is sometimes seen in Epocrates via the Doc Alerts)
Epocrates:
- Has pricing information
- Allows user to identify unknown pill based on pill characteristics (color, shape, etc)
- Ability for you to take notes on the app
They both will likely answer 99% of what you are looking for from a drug-prescribing perspective. So, which do you prefer and why?
Trick of the Trade: NEJM This Week app
How do you keep up with the medical literature?
- You can carry around articles in your lab coat to read when you have a free moment.
- You can read pdf articles on your laptop at home.
- You can listen to podcasts reviewing literature.
About six months ago, the New England Journal of Medicine released a mobile app for the iOS platform (iPhone, iPod Touch). Free-access articles from the past 7 days are available to read. There are also select articles from the Images and Videos series. Audio podcasts are also available which review recent articles.
This a pretty cool app, especially because it's free. It would be great if more journals followed this innovative initiative.
Keeping updated with iPhone medical apps
Here are recent postings:
- How the mobile phone and a UCLA researcher’s imagination are tackling epidemics around the world.
- Eponyms app offers a great free medical database reference tool for Android phones [Review]
- Heart Illustrated is a free well drawn cardiac anatomy app – potentially useful for patient education [iPhone review]
- A milestone in electronic health record adoption: free, web-based Practice Fusion now is the largest commercial EHR
- In the future, your medical app may come from your hospital not from an app store
- iPhone Addiction Disorder (IAD) diagnosed by Psychiatrists in Taiwan
- “Prognosis: Your Diagnosis” app allows clinical case simulation on the iPhone for free [App Review] -
Trick of the trade: Discounted medications at pharmacies
I went to Walmart and Target myself to see if this was indeed true, because frankly I couldn't believe the amazing deals. For example, you can get 20 tablets of ciprofloxacin (500 mg tabs) for only $4.
Download the list of eligible medications and the price list from:
Even more cool is that fact that this same information can be found in a free iPhone app called Generics. Now you can refer patients to the most affordable pharmacy (see below).
Sharing my Paucis Verbis cards on Evernote
Did you know that Evernote allows you to share notebooks? I already have a notebook built for my Paucis Verbis Cards, so that I can access them on my iPhone in the ED on the go. I thought I would share with you, in case you also use Evernote. That way whenever I post a new PV card, your Evernote account should also get my updates.
Instructions:
(click to enlarge)
- From your laptop/desktop, go to this URL link: http://www.evernote.com/pub/michelleclin/paucisverbis
- On the upper right corner of the screen (red arrow), click on the tiny link "Link to My Account"
Don't use Evernote? You might think about trying it out. It's free. Here's my first introduction to Evernote.
Trick of the Trade: OKN drum to test psychogenic coma
Occasionally, emergency physicians see patients who present because they are unresponsive despite normal vital signs and an otherwise normal exam. You detect no drugs or alcohol on board. You suspect a psychiatric or malingering etiology, but aren't sure. They seem non-responsive to voice and minimally responsive to very painful stimuli. Is this a case of psychogenic coma or true coma (with bilateral hemispheric dysfunction)?
What test can you do to reassure yourself that this may indeed be psychogenic coma?
Trick of the Trade:
Test for optokinetic nystagmus (OKN) using an OKN drum.
The optokinetic reflex allows us to follow objects in motion when the head remains stationary. Imagine as if you are a passenger in a car traveling on a highway, watching periodically-spaced telephone poles pass by. This can be reproduced by spinning an OKN "drum" directly in front of a patient. Spin the drum to create an alternating pattern of vertically-oriented black and white bars.
Normal OKN response
The eyes slowly pursue the moving bars in the same direction as the bars. Then quick saccade movement of the eyes in the opposite direction attempt to fixate on the next moving bar. A normal response requires a relatively normal visual acuity and intact fronto-parietal-occipital brain function. This nystagmus eye movement is called the optokinetic reflex. Check out this movie of a normal OKN response from the University of Utah's teaching files.
OKN Drum on the "Eye Handbook" iPhone app
Within the free iPhone app Eye Handbook, there's an OKN drum animation. You can speed up and slow down the pace at which the bars sweep through the screen.
For one particular "coma" patient, placing this screen in front of her revealed a normal optokinetic nystagmus response after "spinning the drum" leftward and rightward. I talked to her as if she were totally awake. I explained that we'd be starting an IV, getting labs, ordering a head CT if she weren't more awake soon. I told her to tell me when she was thirsty so that I could give her some water or juice. I asked her if she wanted to see a psychiatrist. No response. Thirty minutes later, she started talking and requested to talk to her psychiatrist.
Alternatively, a cold caloric test could have been performed to assess brain function.
Free wireless access at Starbucks
As of July 1, 2010, Starbucks shops have opened up wireless access for free. The trade off of this amazing convenience, of course, is digital security. Make sure that your laptop has turned off any file-sharing options and has turned on the firewall security option. With good wireless access at work and home, I can use Starbucks wifi if I really need to check email on my iPhone while on the go. There seems to be Starbucks shops at every street corner these days!
It now makes me wonder how much I really need the 3G network for data access. I've heard rumors that AT&T will no longer be allowing unlimited data plan usage in the near future. They'll be charging money based on your pre-selected data plan.
Given more wifi accessibility now, it may be more cost-effective for me to purchase a simple cell phone and deactivate my iPhone so that it essentially becomes an wifi-capable iTouch with a camera. Hmm...
Happy surfing.
Trick of the Trade: Blowing out the candle
Trick of the Trade: Blow out a candle
With your stethoscope positioned on the patient's back, ask the child to pretend like they are blowing out a birthday candle. Personally I have had variable success with this trick, because the child has to imagine a candle in front of them. Sometimes it works, but other times they just look at me like I'm crazy.
However, what if they had a virtual candle in front of them?
Trick of the Trade (high tech): Candleflame iPhone app
This free iPhone app displays a virtual candle burning for about 20 seconds. It is a slight hassle because a brief ad pops up at the beginning, which you have to manually select to skip over. It's worth the minor hassle, because one can blow out the candle if you sufficiently blow hard enough at the virtual candle. The sensor is the iPhone speaker piece at the bottom of the unit.
Since then, I have used this as a means to grossly assess an asthmatic child's peak flow ability if s/he can't coordinate using a peak-flow meter. You can adjust and increase the distance from the child to the iPhone to encourage maximal expiratory effort.
(Turn audio on in this video to hear me blowing out the candle.)
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