22 03, 2017

Trick of the Trade: Sphenopalatine Ganglion Block for Treatment of Primary Headaches

It is thought that the autonomic nervous system is likely involved in migraines and other primary headache disorders given commonly associated symptoms such as nausea, lacrimation, emesis, and rhinorrhea. The sphenopalatine ganglion (SPG) is an extracranial parasympathetic ganglion with both sensory and autonomic fibers. It has therefore been hypothesized that blockade of the sphenopalatine ganglion may produce relief from primary headaches by modulating the autonomic fibers involved in headache disorders.1

While in our anecdotal experience with SPG blocks has been overall very positive, thus far there have been only a few small studies that have investigated it’s use in the Emergency Department. The currently available evidence has been mixed.

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16 03, 2017

PEM Pearls: 2017 AAP Section of EM’s Guide to Pediatric Community Acquired Pneumonia

Pediatric community acquired pneumonia left side - image courtesy of Dr. Rob CooneyPediatric community-acquired pneumonia (CAP) is an acute, common, and potentially serious infection of the pulmonary parenchyma in children. In November 2010, the American Academy of Pediatrics endorsed “The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America.” [PDF]1Based on this guideline, the American Academy of Pediatrics (AAP) Section on Emergency Medicine’s Committee on Quality Transformation developed a clinical algorithm for CAP in the ED setting.

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15 03, 2017

Beyond the Abstract: Patient video testimonials improve physician interpretation of advance directives and POLST

advance directives and POLST with videoOver 1,300 physicians across the U.S. were asked to interpret patient preferences for end-of-life care in theoretical cases. Physicians rarely reached consensus about patient preferences when they were given only living wills and POLST documents to interpret. The addition of a patient video testimonial helped physicians make better care decisions that reflected their patients’ wishes. Will video become the new national standard for advance care planning?

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13 03, 2017

AIR Series: Trauma Module (2017)

air series traumaWelcome to the Trauma Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index the ALiEM AIR Team is proud to present the highest quality procedure content. Below we have listed our selection of the 21 highest quality blog posts within the past 12 months (as of September 2016) related to Trauma emergencies, curated and approved for residency training by the AIR Series Board. More specifically in this module, we identified 5 AIRs and 16 Honorable Mentions. We recommend programs give 7 hours (about 20 minutes per article) of III credit for this module.

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6 03, 2017

PV Card: Laceration Repair and Sutures – A cheat sheet guide

laceration repair and suturesLaceration repair and suturing are foundational skills for the Emergency Department. This pocket card serves as a quick reference guide for clinicians, and provides a much-needed update and design upgrade from the 2011 PV card on Sutures. This card covers suture/staple removal times, suture sizes, suture material characteristics, special laceration considerations, and suture techniques.

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1 03, 2017

PEM Pearls: Pediatric Sepsis Management – Understanding the Basics

pediatric sepsis managementJust as in adults, pediatric sepsis is a complex topic with continued research. In the United States, there are an estimated 75,000 cases per year of pediatric severe sepsis with an in-hospital mortality of 5-10%.1,2 This is one of the deadliest conditions treated in children. In addition, after the Rory Staunton case, New York State passed regulations requiring all hospitals to have pediatric specific recognition, treatment, and data reporting systems. Several other states have adopted, or are considering, similar requirements. Thus it is critical that emergency physicians understand at least the basics of pediatric sepsis management.

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22 02, 2017

60 Second Soapbox: Messman (Vertigo), Dolcourt (Charcoal), Stiell (C-spine Rules)

60 second soapboxAfter a bit of a hiatus we are back with another round of 60-Second Soapbox! Each episode, one lucky individual gets exactly 1 minute to present their rant-of-choice to the world. Any topic is on the table – clinical, academic, economic, or whatever else may interest an EM-centric audience. We carefully remix your audio to add an extra splash of drama and excitement. Even more exciting, participants get to challenge 3 of their peers to stand on a soapbox of their own! 

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