24 08, 2016

Treat and Release after Naloxone – Is it Safe?

By | August 24th, 2016|Tox & Medications|0 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?’ A hot-off-the-press article, just published in Prehospital Emergency Care, addresses this question.

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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.

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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.

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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!

 

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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.

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17 08, 2016

Diagnose on Sight: Case of a red, swollen neck

By | August 17th, 2016|Diagnose on Sight, ENT|0 Comments

Ludwig's AnginaCase: A 78 year-old female with a past medical history of asthma and hypothyroidism presents with a three day history of sore throat and a two day history of a “lump” along the right side of her neck. The “lump” has now progressed to involve both sides of her anterior neck and is accompanied with erythema, tenderness to palpation, and swelling. In addition, the patient has developed a hoarse voice and odynophagia. The patient’s primary care physician referred her to an ENT specialist, who then referred the patient to the ED for urgent imaging due to the concern for a deep space neck infection. Triage vitals are remarkable for a heart rate of 118 beats per minute. She is otherwise normotensive and afebrile. On physical exam, slight crepitation in noted on the floor of the patient’s mouth. Of note, the patient also informs you of her penicillin allergy. Which of the following is the biggest risk factor for this particular disease process? 

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15 08, 2016

PV Card: Introduction to ED Charting and Coding

By | August 15th, 2016|Administrative, PV Card|0 Comments

ED charting and coding computer-charting-TEXT-canstockphoto17902161What makes a good chart? How do you write a good chart quickly? How about a good, efficient, billable chart? On average, residents and practicing physicians report they did not receive adequate training in charting and coding1–3 and resident charts are more often down-coded due to documentation failures than those of attendings and PAs.4 Thankfully, resident education in charting has improved over the past 15 years,5 and a little learning goes a long way to improve confidence6 and competence.7

In the spirit of #FOAMed, we would like to provide some pearls and pitfalls for EM documentation, starting with a PV card that addresses the basic elements of coding a chart. We hope it’s a handy on-shift reference.

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