Fentanyl: Adding Fuel to the Fire in the North American Opioid Epidemic

Drug poisoning is now the leading cause of injury death in the United States,¹ with opioids accounting for up to 40% of these deaths. In the U.S., prescription opioid death rates have more than quadrupled since 1999, and death rates exceed those due to motor vehicle crashes.² Similar trends in opioid exposure and death rates in Canada suggest that it is not far behind. Prescriptions for opioid analgesics paralleled a rise in opioid abuse and fatalities between 2002 and 2010, leveling off between 2011 and 2013,³ only to rise again in 2014.⁴ Among the more frequently misused opioids nationwide are oxycodone and hydrocodone (the most widely prescribed drug in the U.S.) in their various formulations, and methadone, but a “rising star” in the epidemic in many regions is fentanyl.

(more…)

By Scott Lucyk, MD|2026-06-16T16:08:54-07:00Feb 29, 2016|Tox & Medications|

60 Second Soapbox: Bafuma (IV Antibiotics), Favot (Nod and Smile), & Augustine (Medical Travel)

Get ready for another round of 60-Second Soapbox! Each episode, one 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!

(more…)

By Sam Shaikh, DO|2026-06-16T16:08:58-07:00Feb 23, 2016|60-Second Soapbox|

ALiEM Chief Resident Incubator Must Read EM Journal Articles – 2016 Edition

In November 2013, the blog post 52 Articles in 52 weeks: Landmark EM Articles for EM interns was published on the ALiEM site. Over the subsequent years, many ground-breaking and practice-changing articles have been published. As part of a multi-institutional initiative launched by the ALiEM Chief Resident Incubator (“The Crincubator”), 9 chief residents from across the country pooled together lists of journal articles thought to be most important for the broad spectrum of EM learners. Additional input was obtained from FOAM leaders across the country including Dr. Ryan Radecki and Dr. Jeffrey Kline. These lists can be used by individuals for further learning or by residency programs for journal clubs.

(more…)

By Allison Trop, MD|2019-02-19T18:50:56-08:00Feb 19, 2016|Education Articles, Incubators, Journal Club|

Trick of the Trade: Topical Tranexamic Acid Paste for Hemostasis

Tranexamic acid (TXA) can be used in a wide variety of settings in the Emergency Department for its hemostatic effects. Topical applications of TXA are commonly utilized to control minor bleeding from epistaxis, lacerations, or dental extractions.^1–3 More in-depth reviews of topical TXA can be found on R.E.B.E.L EM⁴ and The Skeptics Guide to Emergency Medicine.⁵

(more…)

By Scott Dietrich, PharmD|2021-05-13T09:40:48-07:00Feb 17, 2016|Heme-Oncology, Trauma, Tricks of the Trade|

Zika Virus: What emergency department providers need to know

The Zika virus outbreak has recently been put on “Level 1” activation status by the Emergency Operations Center at the U.S. Centers for Disease Control and Prevention (CDC). If you haven’t already thought about this affecting your emergency department, you should starting now. A Level 1 status has been triggered only 3 times in the recent years: Ebola (2014), H1N1 (2009), Hurricane Katrina (2005). The following are some key facts and resources.

(more…)

By Lauren Pike, MD|2026-06-16T16:09:00-07:00Feb 15, 2016|Expert Peer Reviewed (Clinical), Infectious Disease|

ALiEM Bookclub: Bouncebacks! Emergency Department Cases: ED Returns

There are many pitfalls the practicing Emergency Medicine practitioner can encounter, but hopefully avoid during their time in the ED. Bounceback patients, the ones who come back the next day, usually worse off than the day before, are definitely dreaded events that most would like to avoid. Of course, the ideal goal would be to never have that happen to you or your patients, but that is just not realistic. That’s why Bouncebacks! can be integral to anyone’s reading list.

(more…)

By Zach Risler, MD MPH|2016-11-11T19:45:21-08:00Feb 12, 2016|Book Club, Incubators, Medicolegal|

ALiEMU CAPSULES Module 5: Procedural Sedation & Analgesia in the ED

We are proud to present CAPSULES module 5: Procedural Sedation & Analgesia in the ED, now published on the Academic Life in EM University (ALiEMU) website. Here is a summary of the key points from this outstanding module by Dr. Zlatan Coralic and Dr. Nadia Awad.

(more…)

By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2017-10-01T20:25:37-07:00Feb 10, 2016|Capsules, Tox & Medications|