About Al'ai Alvarez, MD

Clinical Assistant Professor
Director of Well-being
Co-Chair, The Human Potential Team
Department of Emergency Medicine
Stanford University School of Medicine

ALiEM Statement Against Racism

ALiEM Statement Against Racism

Illustration by Dr. Moises Gallegos

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.

By |2020-06-01T16:43:29-07:00Jun 2, 2020|Public Health|

IDEA Series: Just-in-Time Training for Diagnostic Paracentesis

AP wrist radiograph

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…)
By |2019-12-21T13:00:22-08:00Dec 18, 2019|Academic, Gastrointestinal, IDEA series|

Just-in-Time Training for Emergency Medicine Radial Arterial Line Placement

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.

(more…)

Trick: Peritonsillar abscess drainage 3.0 | All the steps with added variations

Peritonsillar abscess drainage pelvic speculum

A 25-year-old medical student comes in with a muffled voice, sore throat and trismus. You look at the back of her throat and you see the uvula deviated to the right. You astutely diagnosed a peritonsillar abscess (PTA). You consider aspirating and want to check for tips on how to successfully do this.

Dr. Michelle Lin and Dr. Demian Szyld have created great guides for the common and important emergency medicine procedure of draining a PTA (laryngoscope lighting and spinal needle for aspiration; ultrasound localization and spinal needle guard; avoiding awkward one-handed needle aspiration). This update reviews these tricks as well as some additional techniques for optimal success in draining a PTA, while avoiding the ultimate feared complication of puncturing the carotid artery.

(more…)

By |2020-08-13T11:15:27-07:00Aug 9, 2019|ENT, Tricks of the Trade, Ultrasound|

IDEA Series: A Low-fidelity Simulation Workshop for Teaching Cricothyroidotomy

The Problem

idea series teaching residents quality improvement

Cricothyroidotomy is an emergency life-saving procedure that involves surgical placement of a tube through the cricothyroid membrane in order to establish a patent airway for oxygenation and ventilation. The indications for this procedure are when traditional means, such as orotracheal or nasotracheal intubation, are contraindicated or have failed during attempts to establish an emergency airway.1,2 It is a critical skill for emergency physicians but the declining rate of this procedure has resulted in decreased exposure during training.3,4

(more…)

By |2019-03-28T21:25:08-07:00Feb 3, 2019|Critical Care/ Resus, IDEA series|
Go to Top