Being a medical student or intern rotating through Emergency Medicine means you'd see a lot of patients of any age with any complaint on a daily basis. You'd often be unprepared for numerous diseases and complaints that present in the emergency room. Most resources you can use are cumbersome or time-consuming, and not suitable for the hectic ER setting. What you need is the quick reference app that will give you as much information as possible about common chief complaints in the emergency room, as rapidly as possible.
Dr. William "Bill" Dirkes, an EM resident, created a QuickEM app, a rapid bedside reference tool for working up common complaints that can present to the emergency rooms. The app was developed for the medical students and interns, to help them get an idea of the differential, initial workup, and the thought process in the ER setting.
The QuickEM app includes the differential diagnosis, history, physical exam, tests, and treatment recommendations for over 50 of the most common chief complaints present to the emergency room. It also features over 30 most useful clinical decision rules in the ER, as well as tips for medical students and interns, from how to 'rock' EM rotation, to "must know" drug doses and recommended learning resources.
Once you start the app, you'll see that it has simple, well-organized interface. The main sections are listed on the top of the home screen. Here you can easily access adult and pediatric chief complaints, calculators with the decision support tools, tips, and settings.
The adult section contains 36 chief complaints organized by anatomic locations, i.e. neuro, torax, abdomen and extremities, also including vital signs abnormalities, and 5 miscellaneous complaints.
Tapping on any of the complaints, for example chest pain, will open a new screen with a list that contains condensed section headers, from differential diagnosis, history questions, physical exam tips, lab and/or radiology tests, treatment recommendations, disposition, and clinical pearls. In this case (chest pain), the list also contains another section disposition for "low risk chest pain."
Tap again to expand each section. The content within is presented in a really concise manner that is both easy to read and comprehend, which is really important especially in hectic ER setting.
The differential diagnosis section includes the list of both life threatening and common diagnoses. The list is comprehensive and covers most life threatening illnesses that need to be ruled out first. This is why QuickEM works well as a quick reference tool, because it gets you straight to the point.
The diagnoses may be further separated by organ systems, depending on chief complaint you've chosen. You'll notice that some of them are underlined, meaning they're linked to the corresponding WikiEM page. While this takes you to the additional reference information really quick, it doesn't look good design-wise. The view is messed and rotating screen also doesn't help.
Other sections offer information in similar brief, but comprehensive manner, which is ideal for quick reference. However, some sections including history, physical exam, and tests, need better guidance and more detailed content. Else, medical students and interns may find it cumbersome and not so easy to use in their current format.
The treatment section provides recommendations based on diagnosis and includes both medications and dosing. Quick reference format works well here.
Disposition section provides recommendations regarding patient's admittance, discharge or follow-up, which vary for each chief complaint and may depend on cause, potential comorbidity, etc. This section would also benefit more if provided better guidance.
Finally, Pearls section provides useful clinical "pearls" or reminders medical students and interns should keep in mind when working up their patient.
Some of the complaints include useful algorithms, such as head injury or chest pain pearls (PE workup), which are better viewed on a horizontally rotated screen. Others, such as abdominal pain include interactive illustration in DDx section, you can tap on to locate the area of pain and get the corresponding diagnosis.
The Peds section covers pediatric chief complaints, providing the information in the same format as for adults CC. This section includes 15 pediatric complaints organized by age, which are basically just two groups, for neonates (< 1 month), and 1 year or older children, along with Misc. group that includes allergic reactions, BRUE and medication poisoning.
The Calc section provides basic calculators and some of the common decision support rules, including ABCD2 or CHADS2Vasc scores for stroke patients, NEXUS c-spine criteria for post trauma clearance or Glasgow Coma Scale. Each calculator allows you to input values on predefined questions/criteria, calculating the score and giving you recommendations based on that score. It's refreshing to see that quick reference app has actual calculators and decision support tools that can simplify the workday in ER significantly.
There is also Tips section that provides medical students and interns with several practical "how-to" guides, from how to use the app or how to be as best as possible during your EM rotation, patient presentation and discharge instructions, drug doses, to airway mnemonics, or how to interpret EKG.
This section also lists recommended resources for students and interns, from books, websites, apps, podcasts, etc. A lot of these resources are used in making of this app.
There is also a Search field that allows you to find things much easier. But since it only searches within the section and only complaint names, it's practically redundant.
I can only say that I'm very impressed with the QuickEM app. Despite the fact that some parts would benefit from adding better guidance and more detailed information, this app is great quick reference tool for medical students rotating through Emergency Medicine, or new EM interns, which provides more than enough information on common complaints seen in both adult and pediatric emergency departments.
Benefit: Medical students in rotation and medical residents would benefit the most, but the app can also be useful to junior physicians, physician assistants, nurses, etc.