ALiEM AIR | Orthopedics Upper Extremity 2019 Module

Welcome to the AIR Orthopedics Upper Extremity Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to orthopedics upper extremity emergencies. 5 blog posts within the past 12 months (as of March 2019) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 0 AIR and 5 Honorable Mentions. We recommend programs give 2.5 hours (about 30 minutes per article) of III credit for this module.

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By Chris Belcher, MD|2020-09-04T11:10:37-07:00Aug 5, 2019|ALiEMU, Approved Instructional Resources (AIR series)|

elder hand palliative emergency medicine care

The skilled and rapid resuscitation of critically ill patients is a central premise in the specialty of emergency medicine (EM). A paradox for providers often arises when in the midst of resuscitating a patient with advanced chronic illness, the question of risks versus benefits arises. For this patient, we may successfully stabilize vital signs, but at what cost? Will this patient return to a quality of life they deem acceptable? What are the patient’s goals of treatments given his/her underlying disease? These questions illustrate the need for emergency physicians to be more aware of and comfortable with palliative care practices.

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By Beth Krafchik, MD|2019-07-23T00:34:41-07:00Jul 31, 2019|Geriatrics, Palliative Care|

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Chief complaint: Rash

History of Present Illness: The patient is an 18 year-old male who presents with a rash that appeared 7 days ago. The rash is located on his torso, back, and lower lip. It is pruritic. Three days prior to the appearance of the rash, he had a sore throat and intermittently took ibuprofen over the ensuing 3 days. He stopped taking ibuprofen 4 days after his sore throat abated. He denies any fever, nausea, vomiting, shortness of breath, chest pain, abdominal pain, diarrhea, extended travel in the past year, sick contacts, new soaps/detergents, insect bites, chemical exposure, and new foods.

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By Zachary Smith, MD|2019-07-28T21:17:29-07:00Jul 29, 2019|Dermatology, SAEM Clinical Images, Tox & Medications|

New free P3 app: PECARN Publication Prospectus

One of the gold standard for building and sustaining collaborative, multi-institutional research networks in medicine is the Pediatric Emergency Care Applied Research Network (PECARN) organization. Their efforts on studying pediatric emergency care has resulted some of our specialty’s landmark papers in Lancet, New England Journal of Medicine, JAMA Pediatrics, and Annals of Emergency Medicine. Although we are not officially affiliated with them, we fully support their efforts and wanted to help disseminate their evidence-based findings with an educations. Thus was born the PECARN Publication Prospectus (P3) app project [download free P3 app].

The P3 Project and Team

As with many of our ALiEM initiatives, the P3 project arose from a collaborative sprint effort over a 4 week period in 2019 with prehospital educators, emergency medicine (EM) residents, budding and current pediatric EM fellows, and EM/PEM attending physicians. This app plans to be a “living” catalog of PECARN publications which is updated as their prolific research team continues to publish.

Phase 1: Extracting the clinically-relevant educational pearls and a brief study summary from each of their 140+ peer-reviewed papers
Phase 2: Feature expert peer-reviewer commentaries from one of the paper’s authors
Phase 3: Link high-quality online resources which review or highlight these papers

Jessica Chow, MD (Chief Resident, Department of Emergency Medicine, UC San Francisco)
Lamarr Echols, MD (Emergency physician, Northbay Medical Center)
James Gray, MD (Fellow, Pediatric Emergency Medicine, Cincinnati Children’s Hospital)
Ryan Hunter, BS NRP FP-C (Paramedic/ Firefighter, Montgomery Co. Fire-EMS; Critical Care Flight Paramedic, U.S. Army National Guard)
Ginger Locke, BA NRP (Associate Professor of EMS Professions, Austin Community College)
Floyd Miracle, BS NRP (Clinical Manager, Jessamine County EMS)
Damian Roland, BMedSci, BMBS, PhD (Honorary Associate Professor and Consultant in Paediatric EM
Jason Woods, MD (Assistant Professor of Pediatrics, University of Colorado, Children’s Hospital of Colorado
Michelle Lin, MD (ALiEM Founder; Professor of EM, UC San Francisco)

P3 App

The P3 app, which is compatible with iOS and Android devices, summarizes each of the 140+ PECARN publications. These papers are subcategorized into learner groups (physicians/advanced practice providers, pharmacists, triage nurses, prehospital providers, and administrators) as well as organ system groups.

By Michelle Lin, MD|2020-04-19T18:45:16-07:00Jul 24, 2019|Pediatrics|

[Figure 1: Click for larger view]

Chief Complaint: Chest pain

History of Present Illness: An 89-year-old female with a past medical history of coronary artery disease and with recent admission for myocardial infarction that was medically managed, presented with chest pain and shortness of breath. She reports worsening midsternal chest pain that occasionally radiates to her back and right arm since discharge.

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By Andrew Ortega, MD|2019-07-28T21:30:40-07:00Jul 23, 2019|Cardiovascular, ECG, SAEM Clinical Images, Ultrasound|

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Chief Complaint: Flu-like symptoms, lip pain/swelling, mouth pain, eye redness, and rash

History of Present Illness: Patient is a 35-year-old transgender male with a history of bipolar disorder (taking seroquel/lamotrigine) who presents with 2 days of:

Flu-like symptoms
Progressive lip pain/swelling
Mouth pain
Oral ulcers
Eye redness
New erythematous rash involving the palms/soles and lower extremities

The patient initially noted myalgias, fever, and malaise 2 days ago. Yesterday, the patient woke up with bilateral eye redness and itching, and he developed lip swelling/discoloration and mouth pain throughout the day. He presented to an outside emergency department (ED) 12 hours prior, where he was told that he had a viral infection, given pain medication, and discharged home. He has not taken any other medications. The patient presents to this ED due to progression of symptoms, including the development of a pruritic rash on his palms, soles, and lower extremities. Upon further questioning, the patient also reports vaginal itching and a fishy odor. He has a history of bacterial vaginosis and states that these symptoms feel similar. The patient denies genital sores, vaginal discharge, and vaginal bleeding. He is currently sexually active with men and women, and does not regularly use barrier protection.

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By Nicholas Stark, MD|2019-07-28T21:30:17-07:00Jul 22, 2019|Allergy-Immunology, Dermatology, Genitourinary, SAEM Clinical Images|

Severe constipation, requiring fecal disimpaction and rectal enemas, can be excruciatingly painful for patients. Administering sedatives and opioids to help alleviate this pain poses a challenge, because many of the patients are elderly and tend to be more sensitive to these medications. Furthermore, there may be increased vagal tone when straining, leading to hypotension and bradycardia and which can result in defecation-related syncope. ¹ Also, opioids can exacerbate constipation. Herein we present 2 cases and tricks on achieving better pain control.

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By Kara Bragg DNP, APRN, FNP-C, ENP-BC|2019-07-15T18:29:18-07:00Jul 17, 2019|Gastrointestinal, Tricks of the Trade|

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ALiEM AIR | Orthopedics Upper Extremity 2019 Module

What is palliative emergency medicine and why now?

SAEM Clinical Image Series: Rash After a Sore Throat and Ibuprofen Use

New free P3 app: PECARN Publication Prospectus

The P3 Project and Team

P3 App

Want to help?

SAEM Clinical Image Series: Another Heart Attack?

SAEM Clinical Image Series: Flu-like symptoms, oral ulcers, and rash

Trick of Trade: Topical lidocaine jelly to make constipation relief less painful