Emergency Medicine Residents’ Association (EMRA) has continued to produce quality reference guides and mobile phone applications for EM healthcare professionals and its Basics of EM app is no different. So far EMRA has developed the following apps: Basics of EM, Antibiotic Guide, Pressordex, Peds Airway, Peds Meds, EM rashes, EM Resident.
Basics of EM is designed to provide medical students and interns with access to a quick, easy to follow clinical guide to working up 20 of the most common chief complaints typically seen in the emergency department. I first came across this app at the start of my fourth year EM rotation and it quickly became one of my go-to apps. It provided me with broad working differentials broken down by acuity that I could quickly reference right before entering a patient’s room.
When I wanted to assess a patient’s risk for a DVT I could use the built in calculator which had the Wells’ criteria, in addition to other medical criteria. Prior to performing a cardiac or renal ultrasound I could quickly refer to the ultrasound component of the app for a refresher which includes imaging and instructional videos.
The home screen displays all top 20 chief complaints allowing immediate access to your patient’s complaint. If you press the phone icon on the bottom right you are taken to a screen that allows you to store consult numbers by department. The information icon on the bottom right gives you direct access to a medical calculator, powered by MDCalc, and ultrasound instructions, imaging, and videos, powered by 1 Minute Ultrasound. (Remember to check out iMedicalApps review of the top Emergency Medicine ultrasound apps as well.)
MDCalc offers a scoring system for the following: Canadian C-Spine Rule, Canadian Head CT, NEXUS, GCS, Centor Criteria, PERC, Ranson’s Criteria, Ottawa Knee Rule, Pittsburgh Knee Rule, Wells’ Criteria, Ottawa Ankle Rule, SF Syncope Rule. Specific MDCalc algorithms can also be found under the appropriate chief complaint.
The Ultrasound information covers the following topics: AAA, Cardiac, DVT, FAST, Gallbladder, Obstetric, Pneumothorax, Renal, and Soft Tissue. The information covered focuses on indications, probe selection, required views, normal and abnormal images, and videos provided by 1 Minute Ultrasound. Specific ultrasound information can also be found under the related chief complaint.
Selecting a chief complaint from the home screen takes you through a basic workup from start to finish. I want to emphasize “basic”. If you are looking for a tool that will take you through a detailed workup then this is not the app for you.
Basics of EM provides bare-bone, high yield information that allows you to glance through a workup in a matter of minutes. Under each complaint you are first taken through some concerning history and physical exam findings that you need to pay particular attention to.
Next is an algorithm to follow based on clinical and physical exam findings, lab values, and imaging results. The format will differ depending on the chief complaint.
The differential section is commonly divided into dangerous versus benign, acute versus chronic, or by organ systems. For each disease, the table includes bread-and-butter H&P characteristics, diagnostic tools, and treatment options.
The next section covers clinical pearls, followed by documentation recommendations of basic findings you should include in your clinical note. This should not serve as a full write up, but in fact, as a supplement.
Brief Clinical Scenario
Now that we have explored the layout of the app lets go through a brief clinical scenario to see how we would realistically use the app. On the ED board there is a 75 yo M with a headache (HA) that arrived from a nursing home via EMS with stable vital signs. You are aware of the common benign causes of HA, like migraine, tension, or cluster HA. However, as a new EM intern you want to focus your primary assessment on the more life-threatening causes.
You quickly refer to the HA section of Basics of EM and go straight to the differential table and focus on the dangerous causes of HA – paying attention to key history and physical findings and diagnostic strategies. The concerning history and physical exam findings section gives you a rough idea of important questions to ask and physical exams to conduct in order to start ruling out the dangerous causes.
The HA algorithm gives you a rough idea of the different paths that can be pursued. You take one last look at the clinical pearls before entering the patient’s room with a clearer image of how you want to conduct your workup.
Who would benefit from the app?
- Rotating third and fourth year medical students
- EM interns
- Off-service rotating residents
- PAs, NPs, and nurses
It is unfortunate the app is not available for the Android platform.
- Easy to navigate
- Design and content allows for quick review
- Access to MDCalc medical algorithms
- Access to 1 Minute US videos
- Not available for Android
- Not enough MDCalc emergency medicine related algorithms included
- MDCalc and ultrasound listings are hidden away in the bottom right corner of the home screen
- 20 chief complaints could be expanded upon
- After completing two back-to-back EM rotations I can say through first-hand experience that Basics of EM is a fantastic tool for medical students rotating through Emergency Medicine, off service residents, and new EM interns.
- The app seems to be designed for the hectic and fast paced flow of an ED in that it is both easy to use and minimalistic. The ultrasound component by itself is quite extensive and provides ample training information for ultrasound beginners.
- Overall Score
- User Interface
Easy to use and navigate. Differentials are well organized into table format.
- Multimedia Usage
Includes ultrasound images and videos.
- Real World Applicability
After completing my EM rotations I can confidently say that Basics of EM is an essential tool to have on hand for quick reference in the ED setting.
- Device Used For Review
- Available for DownloadiPhoneiPad