Prochlorperazine, Metoclopramide, and Diphenhydramine for Acute Migraine Headache
The 2016 American Headache Society (AHS) released recommendations on managing adults with acute migraine headaches.1 In the November 2017 EM:RAP LIN Sessions podcast episode that I recorded, I realized that I overgeneralized several statements about anti-dopaminergic agents and the use of concurrent diphenhydramine for akathisia risk reduction. So I wanted to clarify things and share a deeper-dive on the topic, thanks to the constructive feedback and help of headache guru Dr. David Vinson and EM pharmacists Dr. Curtis Geier, Dr. Bryan Hayes, and Dr. Zlatan Coralic. Below summarizes the nuanced thought processes in the anti-dopaminergic treatment of migraines.
Penetrating fishhook injuries can be a common occurrence during the warm weather months. Initially, it is important to evaluate what type of fishhook was being used. How many and where are the barbs? What shape is it (treble hook, single hook)? The physical examination requires a thorough neurovascular exam and, if penetration depth is difficult to assess, radiographs should be utilized for further evaluation.
Seasons greetings from the ALiEM team. We have published so many posts this year that you may have missed a few. Did you at least catch the top 10 ALiEM clinical posts in 2017? These are the most-viewed posts in the past calendar year. From nerve blocks, to managing epistaxis, head bleeds, and providing post-ROSC care – check these out as you ring in the New Year!
The standard for diagnosing pneumonia is a combination of the clinical history, physical examination, and chest x-ray (CXR) findings. However, lung ultrasound (US) has been shown to be a reasonable alternative to CXR in children, and may be an appropriate alternative diagnostic imaging modality in the Emergency Department (ED).
It’s time for another installment of 60 Second Soapbox! Each episode, 1 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! 
Welcome to the Gastrointestinal Module! After carefully reviewing all relevant posts from the top 50 sites of the 
