The emergency physician is the modern-day “Batman” of the hospital. We solve most problems with tools carried around our waist. What is the newest and most prolific tool on our Bat Belts? The iPhone. It seems to be as common as a stethoscope these days, and with the release of the iPhone 3G platform, developers everywhere are creating useful medical applications (“apps”) relevant to our everyday practice.

We informally surveyed emergency department providers and came up with the following list of favorite iPhone “Tricks of the Trade.” All applications are available at the iTunes store under “Apps” and can be easily downloaded to the iPhone either for free or for less than $5.

Notably missing is a complete textbook of emergency medicine clinical content for iPhone. Pepid-EM, a widely used and well-regarded reference available for Palm and Windows PDA platforms, was not available for the iPhone as of this writing.

Epocrates

Epocrates Inc. v2.1 released January 2009. Free.

The old standby, still free and still the king. Search or browse more than 3,300 prescription and OTC meds, dosing information, adverse effects, interactions, and pill photos. Frequent updates keep you in the loop on new meds and changing indications. Pill ID is useful in the ED specifically when managing an overdose or suicide attempt or when a patient brings in a daily pill organizer with unknown medications.

The “Essentials” package adds peer-reviewed disease content developed in collaboration with BMJ, references for most major lab tests, and information on hundreds of herbal supplements.

The free portion is more than sufficient for the average emergency physician’s day-to-day needs.

The ECG Guide

QxMD Software. Released February 2009. $4.99.

This brand-new gem features concise explanations with ample high-quality ECG examples from categories including basics of interpretation, waves and segments, chamber enlargement, ischemia, arrhythmias, and a miscellaneous section including pericarditis, intracranial hemorrhage, pacemakers, and common artifacts.

The ECG graphics flip into landscape view, and details are easily seen with a quick “double tap” to zoom. Accompanying each ECG is a succinct description of findings, etiology, and diagnostic criteria, when applicable. The bottom menu allows the user to switch easily between the main categories and a list of sample ECGs by disorder.

There is also a quiz function, which cycles randomly through the entire list of more than 120 ECGs in the program. This is great as a quick reference in the ED or for teaching examples, as well as a quick quiz to stay sharp on your ECG skills.

In addition, it replaces that grimy old book or reference card you’ve had sitting in your pocket since residency.

MediMath

Evan Schoenberg. v2.4 released February 2009. $4.99.

Written by a medical student from Atlanta, this all-in-one app brings together more than 130 commonly used equations, scores, scales, and criteria to your iPhone for instant access.

Perhaps 30-50 of the calculators are relevant to emergency medicine and, with the “favorites” tab, you can add your most frequently used modules for easy access. Oft-invoked but seldom calculated risk scores or mortality indices are now at the emergency physician’s fingertips, with real-time scoring and updating of the outcome of interest.

For example, every additional Wells Criteria risk factor you tap increases the probability of deep vein thrombosis at the bottom of the screen.

Rumor has it that if you e-mail the developer with a useful suggestion for a module to add, he’ll add it!

ACLS

DoctorCalc.com. v1.1 released November 2008. $4.99.

This simple application contains the basic Advanced Cardiac Life Support (ACLS) algorithms in the flowchart format we are all used to.

The program includes a hypothermia algorithm not present in most ACLS quick-reference cards but useful in the ED, especially in the winter.

The “Edema, Heart Failure, and Shock” algorithm is helpful but may be less widely applicable. The “Suspected Stroke” pathway reinforces National Institute of Neurological Disorders and Stroke goals and criteria that are often difficult to memorize, with the notable exception of recombinant tissue plasminogen activator exclusion criteria.

This application is a useful overall tool when you need ACLS in a pinch.

Eye Chart

Dok LLC. v1.1 released October 2008. Free.

This application speaks for itself. This classic Snellen Eye chart is designed to be viewed at a distance of 4 feet, and looks sharp and bright on most iPhones. While not validated or perfect, this tool certainly is convenient in the emergency department, where Snellen charts can be scarce or inconvenient. Coincidentally, 4 feet is beyond arms’ reach of 99.9% of grabby patients.

Dr. Silman is a resident at the University of California, San Francisco (UCSF)–San Francisco General Hospital (SFGH) emergency medicine residency program. Dr. Lin practices emergency medicine at SFGH and is the associate residency director at the UCSF-SFGH emergency medicine residency program. Contact Dr. Lin at michelle.lin@emergency.ucsf.edu for comments or suggestions for other “tricks of the trade.”