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15 10, 2016

Introducing CME for ALiEM via FOAMbase

2017-03-05T14:13:02+00:00

foambase-aliem-logo-sml cmeEver wish you could get Continuing Medical Education (CME) credit for the Free Open Access Meducation (FOAM) you already consume? We are excited to announce that 10 ALiEM articles are now available for AMA PRA Category 1 CME. This is a pilot program in collaboration with FOAMbase and EB Medicine. There is great content on trauma, geriatrics, pediatrics, critical care, and more. We think CME for FOAM is going to be a great way to increase sustainability for FOAM authors while keeping FOAM 100% free and open access.

 

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21 09, 2016

PEM Pearls: Perfecting your pediatric lumbar puncture using ultrasound

2017-10-26T14:33:32+00:00

lp_collect-croppedA lumbar  puncture (LP) is a common procedure that every emergency physician must master. Pediatric LPs can be challenging for even the most experienced clinician due to small anatomy, difficulty with patient cooperation, and lack of frequency performed. A successful procedure is defined by obtaining cerebrospinal fluid and/or performing a non-traumatic lumbar puncture. There are multiple variables that lead to a successful pediatric lumbar puncture including provider experience, use of anesthesia, and patient positioning. Success rates for pediatric lumbar punctures are variable, with a large range from 34%-75%.1

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25 07, 2016

Diagnosing the central slip injury

2017-03-11T00:19:16+00:00
Extensor Tendon Laceration Finger 6 sm

Figure 1. Laceration overlying proximal interphalangeal (PIP) joint of right second digit. (Photograph by Daniel Ting and Jared Baylis)

A 34-year-old cabinet maker presents to your Emergency Department after accidentally getting his finger caught in a drawer. On examination, he has a superficial, clean laceration over the dorsal surface of the right second digit (Figure 1).

In a previous post, we discussed the approach to identifying, treating, and managing extensor tendon injuries of the hand. In it, we advocate for a high index of suspicion for extensor tendon injuries whenever a patient suffers a laceration to the dorsal aspect of the hand. However, lacerations over the PIP joint deserve special mention. In this article, we focus on the diagnosis of a specific type of extensor tendon laceration: the central slip injury.

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18 07, 2016

Extensor tendon injuries of the hand: Emergency Department management

hand laceration -225x300You are working in the treatment area with a medical student and she is ready to review a “straightforward” case with you. She presents a young, healthy 27-year-old man with a laceration over the dorsal surface of the left hand after a kitchen mishap. It appears clean, and she doesn’t suspect a foreign body. The neurovascular status seems okay with the intact ability to extend the fingers. Her plan is to repair the wound and send the patient for follow up in 7 to 10 days with his family physician for suture removal. The wound appears superficial, but you are an astute clinician and wonder if the skin laceration might not be the only injury. Is there an associated extensor tendon injury?

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25 05, 2016

5 Tips for Managing Pain in Older Adults

2016-12-16T15:29:06+00:00

painPain is the most common reason people seek care in Emergency Departments. In addition to diagnosing the cause of the pain, a major goal of emergency physicians (EPs) is to relieve pain. However, medications that treat pain can have their own set of problems and side effects. The risks of treatment are particularly pronounced in older adults, who are often more sensitive to the sedating effects of medications, and are more prone to side effects such as renal failure. EPs frequently have to find the balance between controlling pain and preventing side effects. Untreated pain has large personal, emotional, and financial costs, and more effective, multi-modal pain management can help reduce the burden that acute and chronic pain place on patients.1 There is evidence that older adults are less likely to receive pain medication in the ED.2,3 The first step to improving, is being aware of the potential tendency to under-treat pain in older adults. Here are 5 tips to help you effectively manage pain in older adults on your next shift.

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18 05, 2016

Managing migraine headaches in complicated patients

2017-03-11T00:22:59+00:00

migraineCase vignette: A 42-year-old female presents at 10 pm with a throbbing right frontal headache associated with nausea, vomiting, photophobia, and phonophobia. The headache is severe, rated as “10” on a 0 to 10 triage pain scale. The headache began gradually while the patient was at work at 2 pm. Since 2 pm, she has taken 2 tablets of naproxen 500 mg and 2 tablets of sumatriptan 100 mg without relief.

The patient has a diagnosis of migraine without aura. She reports 12 attacks per month. The headache is similar to her previous migraine headaches. She is forced to present to an Emergency Department (ED) on average 2 times per month for management of migraine refractory to oral therapy. She reports a history of dystonic reactions and akathisia after receiving IV dopamine antagonists during a previous ED visit. The physical exam is non-contributory including a normal neurological exam, normal visual fields and fundoscopic exam, and no signs of a head or face infection. When you are done evaluating her, the patient reports that she usually gets relief with 3 doses of hydromorphone 2 mg + diphenhydramine 50 mg IM, and asks that you administer her usual treatment. What do you do?

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16 05, 2016

Trick of the Trade: Pre-Charge the Defibrillator

Pre-Charge the Defibrillator CPRIn cardiac arrest care it is well accepted that time to defibrillation is closely correlated with survival and outcome.1 There has also been a lot of focus over the years on limiting interruptions in chest compressions during CPR. In fact, this concept has become a major focus of the current AHA Guidelines. Why? Because we know interruptions are bad.2,3 One particular aspect of CPR that has gotten a lot of attention in this regard is the peri-shock period. It has been well established that longer pre- and peri-shock pauses are independently associated with decreased chance of survival.4,5 Can we do better to shock sooner and minimize these pauses?

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