Welcome to the inaugural post for an exciting new ultrasound-based case series called “Ultrasound For The Win!” (#US4TW). In this peer-reviewed case series, we will focus on real clinical cases where bedside ultrasound changed the management or aided in the diagnosis. In our first case, we present a 28-year-old female with shortness of breath.
A 64 year old man with an extensive history of abdominal surgeries presents to the emergency department with abdominal pain and vomiting. Because you suspect a bowel obstruction, you bring an ultrasound machine to the bedside prior to the completion of any laboratory testing or other imaging. A curvilinear probe in the abdominal mode setting was used to scan in all four quadrants of the abdomen looking in both the sagittal and transverse planes.
Intravenous beta blockers and non-dihydropyridine calcium channel blockers are recommended first-line for atrial fibrillation (AF) with rapid ventricular rate (RVR) [1]. In a previous post, Bryan Hayes (@PharmERToxGuy) provided an overview of the data comparing beta blockers to calcium channel blockers for atrial fibrillation rate control in the ED. Here is part 2 of our two-part AF series. (more…)
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?
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.
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.
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.