The year 2020 has been a year of upheaval. The COVID pandemic revealed disparities in healthcare and its effects on marginalized groups such as the Black community. The pervasive effects of structural racism affect all of us, including in medical education. We cannot and must not remain silent. As we honor Juneteenth, #BlackLivesMatter, and #WhiteCoatsforBlackLives, let us reflect on ways we can address racial injustice in our direct environment.
A 25-year-old man presents with 6 hours of penile pain and swelling after recreational penile injection of Trimix (alprostadil, papaverine, and phentolamine). He denies any history of sickle cell disease or penile trauma. On exam, he is in moderate discomfort and has a tumescent penis with a soft glans. You suspect the patient is suffering from ischemic, low-flow priapism. Manual compression and ice application have been attempted with no significant improvement in the patient’s clinical status.
We invite all of you to join the first-ever all-EM residency graduation event to celebrate the #EMClassof2020 who are embarking on their professional careers in an especially tumultuous time in history. Although this online event cannot replace the experience of an in-person departmental event, we hope that we can all take a collective pause to realize how connected we are in EM and even find some joy in these dark times. As a testament to this momentous “leveling-up” event, world-class speakers, Dr. Esther Choo, Dr. Mel Herbert, and Dr. Amal Mattu will headline a series of well-wishes and inspirational words. We have pulled out all the stops and spared no expense to honor YOU, the future of EM!
A 25-year-old woman is brought into the emergency department by friends due to “acting weird.” She was at a rave and is reported to have consumed alcohol, marijuana, and ecstasy. On exam, she is afebrile, tachycardic, normotensive, and breathing comfortably on room air. She is lethargic, mumbling incomprehensibly, and does not follow commands. Her glucose is 115 mg/dL, her pregnancy test is negative, her EKG reveals sinus tachycardia, her ethanol level is 30 mg/dL, and a stat CT head is negative. Her chemistry panel reveals a sodium level of 114 mEq/L. You order a 100 mL 3% sodium chloride bolus, but it may take 30 minutes to arrive from the central pharmacy. At this point, the nurse informs you that the patient is seizing.
Academic Life in Emergency Medicine (ALiEM) stands in solidarity with emergency physicians and learners in denouncing the structural racism and acts of violence that disproportionately affect persons of color. ALiEM denounces the senseless death of George Floyd which adds to the ever-rising numbers of deaths among Black men and women. The dissemination of the now-viral video documenting Mr. Floyd’s last desperate moments has brought a renewed public awareness to a disease that has for far too long afflicted this nation. We see the injustice and disparities in healthcare that are made even more visible during the COVID-19 pandemic. ALiEM is committed to taking action against racism and discrimination and joins the American College of Emergency Physicians (ACEP), the Society for Academic Emergency Medicine (SAEM), and the American Academy of Emergency Medicine (AAEM) in urging frontline healthcare providers, educators, and leaders to promote a safe, equitable, and inclusive learning and patient care environment in emergency medicine. We support diversity in free and open access to medical education and uphold efforts to embrace our common humanity.
According to the National Health And Nutrition Examination Survey, approximately 630,000 adults in the United States have cirrhosis of the liver, 69% of which are reportedly unaware of having liver disease. A diagnostic paracentesis is a simple procedure for identifying spontaneous bacterial peritonitis in cirrhotic patients with ascites. A just-in-time training (JITT) model incorporating low-fidelity equipment readily available in the ED can facilitate procedural teaching of the diagnostic paracentesis.(more…)
A 63-year-old male presents for acute onset of headache, neck pain, and altered mental status. He has a prior history of hypertension and hyperlipidemia but recently lost his insurance and has been unable to fill his medications. As a well-informed 2nd year resident, you suspect the presence of a ruptured subarachnoid hemorrhage and arrange an expedited trip to the CT scanner. The patient’s blood pressure continues to remain elevated and you initiate an antihypertensive drip. You decide that in order to have accurate titration, you need more reliable data and decide to place a radial arterial line. However, the last two arterial lines you placed did not go according to plan! Before you start the procedure, you decide to review the procedure and some common pitfalls in placing radial arterial lines. You remember your attendings telling you during prior attempts to do things a certain way and you want to incorporate these in your practice.