26 07, 2017

Trick of the Trade: Gaze Testing Using “Selfie Mode” on Your Smartphone Camera

2017-07-26T10:35:49+00:00

gaze testingThe NIH Stroke Scale is used to assess the severity of a suspected stroke. It includes 11 neurologic exam components that can be quickly performed at the bedside. The second component of the NIH Stroke Scale is testing of voluntary horizontal eye movements, a.k.a., “best gaze”.1 Gaze is usually tested by instructing the patient to follow the examiner’s hand or pointer finger in a horizontal plane from side to side. This assessment assumes that the patient can comprehend instructions and actively participate in the physical exam.

But… how do you test gaze if your patient is aphasic or unable to follow commands?
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21 07, 2017

ALiEM’s Greatest Hits for Interns: A Curated Collection of High-Yield Topics

greatest hits for interns

Congratulations, you’ve made it! On July 1, thousands of medical students across the country made the transition to becoming Emergency Medicine residents. It was a particularly competitive year for Emergency Medicine, with 99.7% of first-year spots filled despite a whopping 2,047 positions being offered in 2017 (up by 152 spots compared to last year).1 Now begins the most crucial 3 or 4 years of your medical training that will prepare you for the rest of your career in Emergency Medicine.

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19 07, 2017

Management of Major Pelvic Trauma

2017-07-19T21:58:25+00:00

pelvic trauma fracturePelvic trauma frequently is associated with other injuries from the high force required to break the pelvis. Management is focused on stabilizing the pelvis and stopping the bleeding. Due to other injuries requiring emergent surgical stabilization, pelvic trauma is primarily managed surgically with pre-peritoneal packing and external fixation, followed by angioembolization for continued bleeding. Emergency physicians must quickly resuscitate patients while gathering vital information to direct the correct definitive bleeding control strategy. New endovascular techniques such as REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) may change future emergency department strategies and improve mortality in severe pelvic trauma. 
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17 07, 2017

ED Charting and Coding: Critical Care Time

2017-07-25T10:22:12+00:00

After a STEMI activation from the field on Monday morning, the cardiac catheterization team scoops the patient away shortly after the paramedics arrive in the Emergency Department (ED). “Well that was a smooth and seamless resuscitation. The patient was barely in the ED for more than 15 minutes,” you think to yourself. You diligently complete your critical care documentation, noting 20 minutes of critical care time, before seeing your next patient. A few weeks later the chart is bounced back and noted as an erroneous documentation of critical care time. The coding department notifies you that the case will be billed as a Level 3 visit (E/M code #99283). Why is that the case?

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14 07, 2017

MEdIC Series: Case of the Competency Conundrum – Expert Review and Curated Community Commentary

2017-07-12T19:44:22+00:00

Our final case of this season, The Case of the Competency Conundrum, outlined a scenario of residency competency committee members who are divided in their approach to a superstar R4 resident, Josh, who has already completed the requirements of his training program. They struggle with competing opinions surrounding competency based medical education (CBME) early advancement principles and the importance of continued exposure/service.

This month, the MEdIC team (Drs. Tamara McColl, Teresa Chan, Sarah Luckett-Gatopoulos, Eve Purdy, John Eicken, Alkarim Velji, and Brent Thoma), hosted an online discussion around this case with insights from the ALiEM community. We are proud to present to you the curated community commentary and our expert opinions. Thank-you to all participants for contributing to the very rich discussions surrounding this case!

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12 07, 2017

Ultrasound for the Win! 53M with Right Index Finger Swelling #US4TW

2017-07-07T10:21:05+00:00

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real clinical case where point-of-care ultrasound changed the management of a patient’s care or aided in the diagnosis. In this case, a 53-year-old man with history of diabetes mellitus presents with right index finger swelling.

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10 07, 2017

ACMT Toxicology Visual Pearls: Discolored Skin and Urine

2017-07-09T17:57:28+00:00

cyanide poisoning cyanide poisoning

A patient is brought to the Emergency Department by EMS (Emergency Medical Services) from a house fire. The patient’s skin and urine are discolored as shown. What is the most likely cause of the discoloration?

  1. Acute liver failure
  2. An antidote administered by prehospital provider
  3. Carbon monoxide poisoning
  4. Massive hemolysis

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