Trick of the Trade: Dermal Avulsion Injuries 2.0

Take a shortened, piece of rubber tourniquet and encircle the finger, then clamp it with a needle driver.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.

 

 

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Evaluation and Management of Heat Stroke

Heat Marathon -canstockphoto24918889Heat-related illnesses comprise a continuum of disorders ranging from the minor heat edema, heat rash, heat cramps, and heat exhaustion to the more life-threatening condition known as heat stroke. As a general rule, it is involves a process whereby heat gain overwhelms the body’s mechanisms of heat loss. Often it is caused by an impairment of the body’s cooling and adaptive mechanism to effectively transfer heat to the environment, thus leading to a rise in core temperature. 1

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2016-11-11T19:39:56-08:00

Your Patient In Extremis: THAM To The Rescue?

acid_20base_20balanceOne 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.1–6 So what are the options to tilt the acid-base status in our favor?

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PEM Pearls: Migraine Treatment for Pediatric EM Patients

migraine treatment for pediatric em patients © Can Stock Photo / SergiyNYou 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.

After determining that your patient has no neurologic deficits and that this is most likely a primary headache, what can you do to break his symptoms?

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PV Card: Palliative Care Screening in the Emergency Department

Palliative Care canstockphoto3674078What 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?

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Trick of the Trade: Lactated Ringers for Sepsis Complicated by Hyponatremia

Sodium Na canstockphoto12825701An 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.

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Ultrasound For the Win! Case: 38-year-old pregnant woman with acute right-sided abdominal pain #US4TW

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.
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