Techniques for Ultrasound-Guided IV Placement

Imagine a busy evening shift interrupted by the news that the unstable dialysis patient still has no access. Begrudgingly, you drag the ultrasound into the patient’s room. Buried beneath a layer of muscle, a tiny vein lurks below an intimidating artery with a nerve nestled close by. Making matters worse, the patient is becoming increasingly more frustrated. “This always happens. I told them not to remove my last PICC line,” he notes. The use of ultrasound-guided IV improves successful cannulation and decreases complications, but cases like this have caused many emergency providers to resent, even fear, this basic procedure.^1–4 Below, we provide additional techniques to increase your success and to avoid the risks associated with central line placement.

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2019-09-19T17:39:55-07:00

September 19th, 2019 | Ultrasound

By: Kimon Ioannides, MD and Ryan Gibbons, MD |Editors: Jason Woods, MD

National Physician Suicide Awareness Day 2019

To address the growing issue of physician suicide, the Council of Emergency Medicine Residency Directors (CORD), in collaboration with AAEM, ACEP, ACOEP, EMRA, RSA, RSO and SAEM, annually join forces to help highlight the issues and drive change.

At ALiEM Wellness Think Tank, we tackle resident issues such as preventing suicide and burnout, enhancing resilience, and promoting overall quality of life. Suicide is an important topic that affects our physicians and the future of our specialty. We advocate a culture of support, transparency and openness. If you, or someone you know is exhibiting signs of depression or suicidal ideation, please seek help immediately. Together, we can make the cultural shift to support mental health awareness in medicine and decrease depression and suicide rates.

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2019-09-17T09:30:34-07:00

September 17th, 2019 | Life, Wellness, Wellness Think Tank

By: Katie Rebillot, DO and Vytas P. Karalius, MD, MPH, MA

EMRad: Can’t Miss Elbow Injuries

Have you ever been working a shift at 3 am and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This is a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify injuries that ideally should not be missed. This list is not meant to be comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. To begin: “Can’t Miss” adult elbow injuries.

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2019-09-13T09:18:01-07:00

September 16th, 2019 | Orthopedic, Radiology, Trauma

By: Stephen Villa, MD |Editors: Luz Silverio, MD

EMRad: Radiologic Approach to the Traumatic Elbow

Radiology teaching during medical school is variable, ranging from informal teaching to required clerkships.¹ Many of us likely received an approach to a chest x-ray, but approaches to other studies may or may not have not been taught. We can do better! Enter EMRad, a series aimed at providing approaches and improving interpretation of commonly ordered radiology studies in the emergency department. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. To begin: the elbow.

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2019-09-13T09:28:50-07:00

September 16th, 2019 | Orthopedic, Radiology, Trauma

By: Stephen Villa, MD |Editors: Luz Silverio, MD

Peering into Peer Review: How can you participate in peer review?

As part of the ALiEM Faculty Incubator Program, Dr. Anthony Artino, Deputy Editor of the Journal of Graduate Medical Education (JGME) and Assistant Editor for Academic Medicine participated in a Google Hangout with Drs. Antonia Quinn and Teresa Chan where he provided expert insights into the peer review process. His advice and best practices are summarized below. In this interview, the discussion provides an insider perspective to the peer review process and peer reviewer development. This post is the first half of a longer interview with Dr. Artino with the second half discussing addressing peer review comments.

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2019-09-12T12:33:13-07:00

September 13th, 2019 | Incubators, Professional Development

By: Christine T. Luo, MD PhD and Jennifer Mitzman, MD

Building Equipment Kits for Streamlined Care

In the setting of emergent care, the ability to access equipment rapidly and reliably can be a deciding factor in patient outcome. Poor stocking, inconsistent organization, and dispersal of equipment throughout a large geographic area are realities of practice as well as barriers to rapid and effective patient care. Equipment kits are a great way to ensure rapid access to a select set of tools to deal with emergent scenarios. They result in both decreased time to arrival and decreased time to successful completion of procedure.^1,2 Scenarios that can benefit from organized and well provisioned kits include central or peripheral access, airway management, initial stabilization, monitor application, chest tube placement, or cricothyroidotomy. A word of caution: equipment kits are not a substitute for skill and cannot be thought of as a fix-all. They keep a specific set of equipment in an easy-to-locate, all-in-one package for use in a predetermined set of scenarios.

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2019-09-05T08:56:05-07:00

September 11th, 2019 | Administrative, EMS

By: Matthew W. Earle, MD and Christian Young, MD, FACEP

SAEM Clinical Image Series: Hip Pain

$hip pain anterior inferior iliac spine fracture$

[Click for larger view]

Chief complaint: Left hip pain

History of Present Illness: A healthy right leg-dominant 13-year-old male athlete presents with left hip pain after kicking a soccer ball.

He states that he kicked the ball awkwardly and experienced hip pain immediately afterwards. He did not feel a pop or cracking sensation but could not stand after the kick and fell to the ground. He can ambulate but only with significant pain.

He now has 8/10 sharp, non-radiating left hip pain that is worse with movement, weight-bearing and palpation.

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2019-09-09T17:23:16-07:00

September 9th, 2019 | Emergency Medicine, Orthopedic, SAEM Clinical Images, Ultrasound

By: Louis Yu, MD |Editors: Josh Bukowski, MD