PEM Pearls: Calming techniques while repairing a laceration
Most children who come into the Emergency Department present with pain or experience pain during their ED stay.1,2,3 Pain and distress during a procedure can leave a lasting impact on a child and contribute to mistrust of the medical system and compliance with future procedures.1 ,4,5 Children who use active forms of coping report less pain and distress during a procedure.3 To help with coping, when feasible, involve parents or family, nursing and a child life specialist. If the parents are willing, try to get them involved in all parts of the medical procedure.2,3 This includes positioning the patient with a parent in a secure parental-hugging hold or maintaining close physical contact throughout the procedure.6 This can easily replace immobilization of a child or the use of restraints which can cause increased fear and escalate the degree of anxiety in a child.2
A 2-month old boy was brought in by his mother after an episode of the child’s face turning blue and a pause in breathing. Mom reports this lasted a few seconds. The mother was terrified, so she brought the baby to the ED.
A peer review process, in one form or another, has long been the de facto standard for academic publishing. In 2013, ALiEM was the first FOAM resource to initiate an attributed peer review process for all submitted content–effectively bringing a traditional standard to a new frontier of medical education.
Seasons greetings from the ALiEM team. We have been publishing so many posts this year that you may have missed a few. Did you catch at least the top 10 most-read ALiEM clinical posts, which were published in 2016? These include some Tricks of the Track pearls and clinical tips in toxicology, orthopedics, and neurology. Check them out.
For the third consecutive year, we provide a quick summary of some important Emergency Medicine pharmacotherapy articles from the last 12 months. We have tried to focus on articles you may have missed, but are potentially high-impact for improving clinical practice in the ED. Without further ado, we present the 8 must-know EM pharmacotherapy articles of 2016.
Medical providers commonly encounter patients in the emergency department who state they are anticoagulated with warfarin, but they have no idea what dose they are taking. “I know that I take two pills of warfarin daily.” Dosing becomes critically important especially when continuing their medication as an inpatient, refilling their medications, or adjusting their outpatient dose because of an inappropriately high or low INR level. How can you determine the patient’s warfarin dose?