29 08, 2016

Radiograph-Negative Lateral Ankle Injuries in Children: Occult Growth Plate Fracture or Sprain?

By | August 29th, 2016|Pediatrics|0 Comments

Lateral Ankle Injuries in ChildrenAn 7-year-old girl presents to your Emergency Department (ED) with an ankle inversion injury from while performing gymnastics. Plain films of her ankle show no fracture. It has been a long-held presumption that skeletally immature children with fracture-negative radiographs should be immobilized with a cast given the concern for an occult Salter-Harris 1 fracture. “Children do not get sprains” is a common teaching point. But a recent 2016 JAMA Pediatrics article challenges that premise in a prospective cohort study of 135 pediatric patients.1 Can these injuries be managed more like a sprain, utilizing a removable ankle brace?


28 08, 2016

ALiEM Book Club: Beyond the ED – Recommendations by Dr. Ed Newton

By | August 28th, 2016|ALiEM Book Club, Beyond the ED|0 Comments

“That is part of the beauty of all literature. You discover that your longing are universal longings, the you’re not lonely and isolated from anyone. You belong. ”
– F. Scott Fitzgerald

If the mark of a person are the people they have directly influenced, then Dr. Ed Newton is in rarefied company. He trained in Emergency Medicine at LAC+USC at a time where there were serious concerns about the legitimacy and the long-term future of the field. After finishing a fellowship in medical toxicology, he has held nearly every position in the LAC+USC Department of Emergency Medicine. He is a former Program Director, Vice-Chair, and Chair. During his time he had played a direct role in shaping the careers of people like Drs. Billy Mallon, Stuart Swadron, Jan Shoenberger, Mel Herbert, and a long list of who’s who in Emergency Medicine. Beyond the department, his influence stretches nationally through his work with AAEM, SAEM, ACEP, ABEM and the AMA and internationally through his work in Haiti, Ghana, Nepal, Mexico, India, and Sierra Leone.

Knowing him, you are struck not by his gravitas but by his gentleness and depth of thought. We are excited by the opportunity to have him share his recommendations in this Book Club: Beyond the ED post and to give you a sliver of the Ed Newton that has touched so many of us.


24 08, 2016

‘Treat and Release’ after Naloxone – What is the Risk of Death?

By | August 24th, 2016|Tox & Medications|6 Comments

NaloxoneOften in the prehospital setting, naloxone is administered by EMS (or possibly a bystander) to reverse respiratory and CNS depression from presumed opioid overdose. The patient then wakes up, and not uncommonly, refuses transport to the hospital. The question is: Is it safe to ‘treat and release?’ Or, rather, what is the risk of death associated with this practice. A hot-off-the-press article, just published in Prehospital Emergency Care, addresses this question.


22 08, 2016

Trick of the Trade: Paraphimosis – Pour Some Sugar On Me

By | August 22nd, 2016|Genitourinary, Tricks of the Trade|0 Comments

paraphimosisParaphimosis occurs when a retracted foreskin can’t be reduced back over the glans of the penis. Risk factors for paraphimosis include scarring, vigorous sexual activity, chronic balanoposthitis, and forgetting to replace the foreskin after catheterization or manipulation.

Paraphimosis can be a urological emergency as the tight ring formed by the foreskin can cause ischemia to the tip of the penis and eventually gangrene. Timely reduction is of high importance. Treatment involves gentle compression of the glans and gradual manual foreskin retraction.1 Unfortunately, as time goes on, more swelling occurs making traditional reduction techniques more difficult.


21 08, 2016

ALiEM Bookclub: Beyond the ED – Recommendations by Dr. Louis Ling

By | August 21st, 2016|ALiEM Book Club, Beyond the ED|0 Comments|Editors: Nikita Joshi MD

“Words can be like X-rays if you use them properly — they’ll go through anything. You read and you’re pierced.”
― Aldous Huxley, Brave New World

Dr. Louis Ling is currently Professor of Emergency Medicine and the Senior Vice President for Hospital Accreditation at the Accreditation Council for Graduate Medical Education (ACGME), however he is probably best known as one of the founders of Academic Emergency Medicine. He practiced for over 30 years at Hennepin County Medical Center (HCMC) where he ran the program in medical toxicology and served as the Associate Dean for Graduate Medical Education as well as the Chief Medical Education Officer. He has laid the groundwork for much of what we do now by starting the journal Academic Emergency Medicine as well as helping to found the Council of Residency Directors (CORD).

Beyond his accomplishments, to talk to him is to talk to person who not only has the experience but both the willingness and ability to continue to think deeply. He continues to inspire many of us, not by his accomplishments but by his continued enthusiasm that he brings to the whatever he is working on. ALiEM is excited to have Dr. Louis Ling share his book recommendations in this edition of ALiEM Bookclub: Beyond the ED.


20 08, 2016

I am Dr. Carl Alsup, Ultrasound Fellow: How I Stay Healthy in EM

By | August 20th, 2016|Healthy in EM|0 Comments

Dr. Carl Alsup is an emergency physician and ultrasound fellow at Thomas Jefferson University. His loves for the outdoors keeps him active and fit. Despite being busy with academic commitments, Dr. Alsup maximizes his wellness by incorporating it into his daily routine. His attitude and strategies on maintaining mental wellness are refreshing, and are definitely worth checking out. Here is how he stays healthy in EM!



18 08, 2016

Trick of the Trade: Ear Irrigation in the Emergency Department

By | August 18th, 2016|ENT, Expert Peer Reviewed (Clinical), Tricks of the Trade|7 Comments

Ear pediatricEar irrigation is an important tool for adult and pediatric patients in the Emergency Department (ED) with ENT complaints. Irrigation can be used to clear ear cerumen, visualize tough-to-see tympanic membranes, and remove foreign bodies. This may reduce the need for subspecialist care and improve the patient’s hearing and quality of life.1 Commercial electronic and mechanical devices are available for irrigation and have been studied. Moulton and Jones presented the improved efficacy of foreign body removal using an electric ear syringe in an (ED) population.2 In this trick of the trade, we present a low cost and effective way of  “ear-rigation” taught to us by one of our veteran nurses using easily available tools in the ED.