A new academic year is upon us! Across the country, emergency medicine interns are orienting to their new hospitals and preparing for their first day as “doctor.” But before we look forward, what lessons can we learn from 2018 EM Residency Match cycle? In this EM Match Advice series installment, Dr. Michael Gisondi (Stanford), Dr. Michelle Lin (UCSF), and an esteemed panel of program directors discuss how competitive EM was in 2018, the standardized video interview, and the number of programs an average applicant should apply to this year. Bonus: we introduce the Lin-Gisondi correction factor, a (mostly facetious) tool to help applicants weigh the advice of their mentors!
Most protocols for managing pediatric patients with diabetic ketoacidosis (DKA) are based on a theoretical association between fluid resuscitation and subsequent neurological decline. Although the evidence for an association between IV fluids and cerebral edema comes from retrospective reviews, for over 20 years, it is an accepted teaching principle of pediatric DKA.
Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis, published just days ago in the New England Journal of Medicine, challenges this teaching with the first randomized controlled trial designed to investigate the relationship between IV fluids and cerebral edema. We review this publication and present a behind-the-scenes podcast interview with lead authors Dr. Nathan Kuppermann and Dr. Nicole Glaser from the Pediatric Emergency Care Applied Research Network (PECARN). (more…)
MEdIC Series: The Case of the Overwhelmed Senior Resident – Expert Review and Curated Community Commentary
Our eighth case of season 5, The Case of the Overwhelmed Senior Resident, presented the scenario of a senior resident who felt overwhelmed when left to manage the department on a busy night shift while his attending physician was asleep in the back room. The resident debated whether to wake his attending to ask for help, but worried that it could be perceived as a sign of weakness or that he couldn’t “handle things” with autonomy. If you haven’t had a chance yet, we urge you to check out the case and share your thoughts on this important topic!
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 the case over the last 2 weeks with insights from the ALiEM community. We are proud to present to you the curated commentary and our expert reviews. Thank you to all participants for contributing to the rich discussions surrounding this case!
Despite the widespread clinical use, and their well-documented life-saving properties, vasopressors are often maligned, accused of causing ischemia to fingers, toes, mesentery, kidneys, and so forth. Not only is the evidence that this happens poor, but, a fear of this dreaded complication can unwarrantedly lead good clinicians to limit or withhold potentially life- and organ-saving medications. This article showcases the importance of end-organ perfusion and explains how vasopressors may in fact be one of the most important therapies in an emergency physician’s armamentarium.
Emergency ultrasound (EUS) has quickly become a fundamental aspect of emergency medicine (EM) residency training. While still relatively novel to the field, there has been a significant focus on curriculum development in accordance with the core ultrasound application guidelines set forth by the American College of Emergency Physicians (ACEP).1 Currently, there is no consensus on the optimal approach to EUS education that will provide learners with true clinical competence post-matriculation. Furthermore, a recent survey demonstrated that there is conflict between what ACEP guidelines consider to be competence in EUS and resident opinion on the matter.2 One potential identified issue with our current model is the focus on early ultrasound learning in junior EM residents with a lack of ongoing EUS education in senior years.
Musculoskeletal pain is a common ED presentation and emergency providers can often manage it with NSAIDs alone.1 On the other hand, when patients present with small localized areas of intense muscle spasm called trigger points, NSAIDs won’t cut it. A trigger point injection (TPI), however, is a safe and easy way to treat the underlying cause of trigger point pain, and requires only basic equipment already available in most the EDs.
Ever wonder what would happen if you were working in the emergency department (ED) when a nuclear attack happens? We’ve all had questions on boards or inservice exams about the long-term effect of radiation exposure, but would you know what to ACTUALLY DO if a nuclear attack happened? What do you do in the first few minutes? First few hours? We know that if you are in the immediate bomb vicinity, there is not much you can do. But what if you are 5 miles away? Or 10 miles?
If you look for information regarding nuclear attacks, there are no great summary resources on what to do in the immediate aftermath if you are in the ED. In order to bring this to you in an easily digestible format, we have broken this post up into a few topic areas: This blog post will cover (1) what physically happens in a nuclear attack and (2) what this means in the ED.