I am giving prochlorperazine. Should I give diphenhydramine too?

Prochlorperazine is a commonly used medication in EM. In certain patients prochlorperazine does wonders for migraines, and remains a great antiemetic choice for undifferentiated nausea/vomiting when ondansetron is ineffective. However, prochlorperazine has antidopinamergic activity increasing the chances of extrapyramidal symptoms (EPS), such as akathisia, dystonia, parkinsonism, and rarely tardive dyskinesia. A common practice in the ED is to give diphenhydramine with prochlorperazine to attenuate EPS. Does this really work? What is the evidence?

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By Zlatan Coralic, PharmD|2019-02-19T18:41:26-08:00Sep 3, 2014|Tox & Medications|

Diagnose on Sight: Swollen Upper Extremity in a Patient with End Stage Renal Disease

Case: A 45 year old female with end-stage renal disease presents with 2 days of worsening pain, swelling, and color change of her left upper extremity. The symptoms began after her left arm arteriovenous (AV) fistula was accessed for hemodialysis. The skin is tense and a bruit is present. What is your diagnosis for this swollen upper extremity? Click on the image for a larger view.

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By Jeff Riddell, MD|2016-12-22T20:07:29-08:00Sep 2, 2014|Cardiovascular, Diagnose on Sight, Ultrasound|

AIR Series: HEENT Module 2014

Welcome to the second ALiEM Approved Instructional Resources (AIR) Module! In an effort to reward our readers for the reading and learning they are already doing online, we have created an Individual Interactive Instruction (III) opportunity utilizing FOAM resources for US Emergency Medicine residents. For each module, the board curates and scores a list of blogs and podcasts. A quiz is available to complete after each module to obtain residency conference credit. Once completed, your name and institution will be logged into our private Google Drive database, which participating residency program directors can access to provide proof of completion.

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By Andrew Grock, MD|2017-03-05T14:14:15-08:00Sep 1, 2014|Approved Instructional Resources (AIR series), ENT, Ophthalmology|

ADJUST-PE Study: ALiEM-Annals of EM Journal Club

We are very excited this month to bring you our fourth ALiEM-Annals of EM Global Journal Club on the use of age-adjusted D-dimer levels to help exclude the diagnosis of pulmonary embolism (PE). We hope you will participate in an online discussion of the four posted questions below from now until August 29th. Respond by commenting below or tweeting (#ALiEMJC). Mark your calendars: On Thursday, August 28th at 16:30 CST (17:30 EST), we will be hosting a 30-minute live Google Hangout with Drs. Jeff Kline and Jonathan Kirschner, the authors of the Annals of Emergency Medicine Journal Club for the ADJUST-PE Trial, that is informed by the discussion. Later this year, a summary of this journal club will hopefully be published in Annals of EM.

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By Salim Rezaie, MD|2017-03-05T14:18:40-08:00Aug 25, 2014|Cardiovascular, Journal Club, Pulmonary|

Inviting contributors to ALiEM: An open peer-reviewed content submission process

Over the last several years, ALiEM has recruited a team of regular contributors, each with their own individual passions within the entire breadth of Emergency Medicine. ALiEM has provided these individuals with a global platform capable of carrying their message to a target audience of thousands of regular subscribers. Furthermore, the evolution of a rigorous pre-publication Expert Peer Review process has helped ensure that the content is especially polished and scientifically accurate.

Today marks a new day. The overwhelming success of the website and editorial process has led us to what we feel is the next step for this academic blog and online medical education: peer-reviewed community content submission.

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By Derek Sifford|2019-04-05T17:05:42-07:00Aug 22, 2014|Emergency Medicine, Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical)|

Diagnose on Sight: Palmar Rash

Case: A 41 year old male with one week of non-pruritic palmar rash that started on his trunk and spread to his hands. He has no history of travel, fever, joint pains, or medication use. What is your diagnosis for this palmar rash? Click on the image for a larger view.

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By Jeff Riddell, MD|2016-12-23T19:58:02-08:00Aug 19, 2014|Dermatology, Diagnose on Sight, Infectious Disease|

Trick of the Trade: V-to-Y flap laceration repair for tension wounds

You see a patient with a large V-shaped laceration under tension requiring suture repair. Resist the temptation to simply pull the edges together and close the laceration with simple interrupted or running sutures. Excessive tension on a flap edge during the healing process can compromise its blood supply. This causes ischemia to the healing tissue, which in turn makes that flap edge more likely to dehisce, necrose, and become infected.

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By Brian Lin, MD|2016-11-11T19:22:28-08:00Aug 16, 2014|Trauma, Tricks of the Trade|

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