Being one of the fast paced fields of medicine, emergency medicine requires quick judgment and quicker references.
While the rural emergency department I worked in for the past month was stocked with Tintinalli’s Emergency Medicine, patients always seemed to come in packs, and there was often limited time to make crucial judgments.
Indeed, cracking open Tintinalli’s or even UpToDate was quite far from my mind in a time crunch, and judging by the dust collecting on the book, it was also far from the minds of the emergency physicians.
With only one emergency physician on staff at a time, what could I use to expedite the sore throat and query ankle fracture before the paramedics arrived with a STEMI with an ETA of 10 minutes?
palmEM: Emergency Medicine Essentials by palmER Worldwide is a universal iOS app that fills this role well, with key points for key emergency medicine topics covered and distilled to the core for quick reference.
palmEM covers many topics; be it an emergent postoperative endophthalmitis or a pneumonia that doesn’t need admission, a diverse number of complaints that may present to emergency are included, organized by field of medicine. The topics are by no means comprehensive reviews of the subject; they are designed as a quick refresher of the material for those who have previously learned it.
The next section of the app is for pediatrics. Calculating fluids and medication doses by age or mass are a must for every pediatric patient, and as many medical students can attest to, memorizing these formulas and values can be very frustrating. Luckily, palmEM has a “Pedi Tape” section that lists these values and formulas; just select a mass or age that corresponds to your patient.
Whether it’s selecting the proper-sized needle for a tube, knowing the range of normal vitals for a toddler, giving the proper dose of dexamethasone, or the rate of D50 to infuse in the setting of hypoglycemia, I found this section to go far above the material I was taught and expected to memorize on my pediatric rotation.
The third section focuses on medications. Again, the app makes no attempt at competing with other comprehensive drug references. This section only lists pertinent information such as doses, dosing, adverse effects and maximum dose. Prescribers will need to know the drug prior to looking it up in palmEM, because the app’s quick tips only cover the numbers and information that are otherwise difficult to know cold.
The clinical decision rules section I found to be very helpful. In the introduction, I talked about a hypothetical but not unrealistic scenario in the rural emergency department. Not being able to treat the simple sore throat or sprained ankle quickly could mean their slipping through the cracks, especially when the STEMI arrives and demands the attention of the 2 nurses and 1 physician staffing the rural emergency room. The clinical decision rules listed here are quite useful in these situations. One could quickly assess the patients with the Centor Criteria and Ottawa Ankle Rules prior to discharging them and preparing for the arrival of the STEMI.
The final section is a simple search section for those who know exactly what they want and are happy bypassing the multiple menus.
palmEM promises to be a rapid and succinct quick reference for emergency medicine, and in that respect, it largely succeeds. Everything is clearly organized and presented in such a way that a few quick glances can refresh knowledge from the past. The focus is rightly focused on important point-of-care information, especially the important information that is difficult to memorize cold.
The downside to this is, of course, is that its brevity necessitates that many details be omitted. It is therefore not recommended that learners rely completely on this app as the one-stop-shop for emergency medicine information. Learners must have pre-studied the presenting conditions prior to walking into the ER.
Another strength is that the app is now available for offline viewing, eliminating the need for an internet connection (sometimes a luxury, especially in a rural ER), and reducing the load times to practically zero.
Overall, palmEM is an excellent, rapid point-of-care reference perfectly designed for the time crunch of the emergency department. Its succinct design works well with either the iPhone or iPad, and because it is a universal app, users needn’t be torn choosing between either well-optimized versions.
At its current price of $9.99, it isn’t the cheapest app in the app store nor is it prohibitively expensive. Medical students and residents working in the ER would benefit most from this app, as it is much better for point-of-care than it is for studying and learning. Experienced emergency physicians may find that the material isn’t as illuminating for them anymore, as it does not delve very deep into each topic.
- Succinct collection of emergency medicine pearls
- Great for rapidly skimming at the point-of-care, ideal for the ER
- Works perfectly on either iPhone or iPad
- Usefulness could be improved with menus that expand to delve further into the subject (ie. how to decide on a choice of antibiotic), increasing the value of the app without sacrificing speed
- palmEM: Emergency Medicine Essentials is a succinct and quick universal iOS reference app
- Ideal for the time crunch of the ER due to its speed.