Trick of the Trade: Dermal Avulsion Injuries 2.0
This year I published a Novel, Simple Method for Achieving Hemostasis of Fingertip Dermal Avulsion Injuries in the Journal of Emergency Medicine 1 — a technique I’ve used in my local ED for several years. In brief, this involves achieving hemostasis over a fingertip skin avulsion by using a tourniquet followed by tissue adhesive glue. After bringing the technique to press and sharing this video, I’ve received great tips from peers and subsequently refined it with some additional ideas. Thus I present for the first time on ALiEM: Dermal Avulsion Injuries 2.0.
One of the final common denominators dictating the success or failure of any resuscitative effort, be it a trauma or medical code, is the patient’s acid-base status. In the presence of acidosis, many of the tools at your disposal, including vasopressors, become impotent and the patient’s ability to strike a balance between bleeding and clotting or mounting an appropriate inflammatory response become deranged.
You are working your evening shift at the pediatrics emergency department, and you walk into a darkened patient room with a distressed mother and her otherwise healthy 10-year old son who is curled in a ball, holding his head and crying. Her mother tells you that the around-the-clock ibuprofen has barely touched his 2-day headache.
What is Palliative Care? It is specialized medical care focusing on improving the care and quality of life for patients with advanced illness by decreasing suffering. It can be delivered concurrently with curative care. Early identification of patients who are likely to benefit is key. How do you decide whether your patient could benefit from a palliative care consult?
An 82-year-old female is brought into the Emergency Department by family for a several day history of progressive altered mental status. You initiate a broad workup. However, soon after initial evaluation, you are called back into the room. The patient’s vitals are as follows and concerning for septic shock and an alarming serum sodium level.
Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this peer-reviewed case series, we focus on real clinical cases where bedside ultrasound changed management or aided in diagnoses. In this case, a 38-year-old pregnant woman presents with acute right-sided abdominal pain radiating to her flank.