The All-In-One Swiss Army App

While most mobile apps hone in on a single task, Epocrates Essentials sets out to be everything to everyone. Originally conceived as a drug database for handhelds in 1998, Epocrates has grown into a full-fledged medical reference, now including practice tips and medical news updates.

How it Works: Epocrates Essentials for handhelds allows you to search for a diagnosis by organ system, complaint, or through a differential diagnosis tool. Once you’ve settled on a diagnosis you’re taken to a home page for that malady that may include everything from pictures to reference pages. The disease home page contains a highlights section with a brief synopsis of all pertinent information for the illness as well as everything you might need to fully diagnose, work-up, treat, and disposition a patient.

Why You’ll Love It: First, you’ll love Epocrates’ excellent collection of sharp images, ranging from EKGs to radiographs and photos. Click through to a treatment and the app suggests therapies and drug dosages. Imbedded hyperlinks for the drug itself allow you to look up all the pertinent info you’d expect from an excellent drug reference. Complimenting this drug reference is a drug interaction database allowing you to enter multiple medications and then displaying their possible interactions. You can also tailor your drug database with several popular formularies that are included in the database. Epocrates also has a medical calculator that has over 40 formulas (which you can separate by categories) with a numbers-only keypad making input much faster. 

 

1a. Second, you’ll be impressed by the Epocrates pill identifier. Essentially, you enter all of the basic characteristics of a pill and then the software displays medications that meet that description. A tap on a given medication shows a picture that you can use to compare to the pills in front of you. This is a wonderful tool that can be used at the bedside to wow your colleagues when treating an unknown overdose.

Problem Areas: There are a few areas such as labs that do not hyperlink and as the hyperlinking is so extensive you really notice when it’s not there. Epocrates also does not allow cut and paste, making it difficult to do a quick side search in the absence of hyperlinking. Another minor complaint is the page layout. Branching pages prevent you from quickly scrolling through all of the information on a page. Also, since Epocrates is not specifically designed for an emergency medicine audience there is a lot more information on a given topic than you will likely need. Finally, with Epocrates Essentials running $159 for one year or $269 for two years, price is a definite barrier. This is an expensive product, but considering all that it offers, it is, in my opinion, money well spent. You will, however, have to decide which all-in-one product is worth your money. For me the more expensive PEPID ($429.95 for two years) with its emergency medicine focus barely edges out Epocrates as it offers quicker access to the pertinent information I need as an EP.


The Multi-Function Solutions

The MediMath Medical Calculator is the most comprehensive of the medical calculators. The input method and layout are very similar to other medical calculators but MediMath has 135 formulas in its armamentarium. Not that you’ll use  even half of them, but my logic has always been, “Better to have and not need than need and not have.” MediMath also does a nice job of grouping the calculators into categories and allows numeric input through a larger number-only keypad. Of course, this thoroughness comes at a price. While our other calculator apps cost less than a soda, MediMath will cost you a Starbucks latte. While $4.99 is not a lot in the grand scheme of things, if you’re an app junkie like me it adds up quickly.


For those not familiar with this pocket book it is an annual publication put out by the Emergency Medicine Resident’s Association. Free to their members, the pocketbook alone made the annual dues worthwhile. Think of it as the practical physician’s Sanford guide. It breaks down infection by organ system and, unlike Sanford’s cryptic pages, provides a very clean interface for quickly and easily selecting the recommended antibiotic. You can select infection by organ system or diagnosis. The guide then allows for further differentiation such as Hospital Acquired Pneumonia vs. Community Acquired Pneumonia as well as consideration for co-morbidities. You will then see a list of multiple antibiotic choices showing dosing and duration as well as options for pregnancy and common allergies. So you’ll nearly always have an alternative for that pregnant patient who’s mom once told her that she had flushed cheeks after a penicillin shot when she was 4. The guide also includes treatment options by organism and has a section for special topics. As of press time the special topics have thorough tips for adult, neonatal, and pediatric sepsis. I currently own several of the more expansive programs which are very capable and offer head-to-toe information from initial assessment to differential diagnosis as well as treatment and disposition. Despite this, when I need a quick reference for an antibiotic choice I have always reached for my EMRA Antibiotic Guide as I’ve yet to find a product with a cleaner search feature. However, no software product is perfect. For instance, the clean, quick interface saves your place when you tab to a new section. This is nice when moving back and forth during a single session, but it would be great if you could set preferences so it reverts back to a default page when the program is closed. I often find myself searching through subsets of pages when I restart the app, tabbing my way back to the intro page. My other gripe is the price. While I love the product and will continue to upgrade annually, I think that $15.00 is a bit steep for an iPhone app when you consider that the average medical app (excluding the big guns) runs in the $5.00 range. Despite this, I’m delighted to have a digital version of my EMRA guide at the ready 24/7.

 

 

The One-Trick Ponies


The ABG app allows you to simply enter info from a patient’s Arterial Blood Gas and Comprehensive Metabolic Panel. It then tells you whether this is a metabolic, respiratory, or mixed problem. For those of us who have lost the acid-base neural-net from med school this is a valuable tool. In addition to acid/base info, ABG also has a handy calculator that allows you to enter ABG values along with a desired PO2. The program then calculates what FiO2 will likely get you to your PO2 goal making it a great tool for the ICU or the ED that frequently functions as an ICU.


With this simple app you just enter the patient’s last menstrual period via the iPhone’s easy dial interface and the calculator spits back the estimated gestational age as well as the estimated date of confinement. Simple and useful.
 

This app is simply a Snellen chart that measures visual acuity down to 20/20. Snellen charts are a great pocket visual acuity tool, but as an Air Force flight surgeon I know how easy it is to memorize the lines of a Snellen Chart. EyeChart defeats this by adding randomization to its chart. Simply tap the die in the corner and a new eye chart pops up.

As its name implies, Cardio Calc focuses mainly on cardiac equations but also contains many calculators that an EP would find useful in their daily practice such as an OB wheel, free water deficit calculator, and pulmonary embolism risk measurement tool. Most formulas allow you to check boxes by tapping and input numbers via the keyboard. Input is simple and quick, but I’d like the program to present a larger-keyed, numeric-only keyboard when the input is numbers only (nearly all circumstances). While Cardio Calc has a narrower focus than our other calculators it has most of the calculators the average EP frequently needs, with 78 formulas in all (grouped by organ system). QxMD also allows you to expand your inventory with their Heme, Neph, and GI Calc Apps. And since they are all free apps you can have them all for the price of a drink of water. Having four separate calculator apps to do the work of one may not be ideal but the price is tough to beat.

Disclosure: Dr. Wagner received a one-year evaluation subscription to Epocrates Essentials.

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