Happy 2019 from the ALiEM team. We have published so many posts this year that you may have missed a few. Did you at least catch the top 10 ALiEM clinical posts in 2018? These are the most-viewed posts in the past calendar year. From can’t-miss ECGs, to common splint techniques, and new strategies for managing alcohol withdrawal – check these out as you keep celebrating the New Year!
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A patient presents to your ED with an all too common complaint – chest pain. After a focused history and physical exam, you have an extremely low clinical suspicion for thoracic aortic dissection, pulmonary embolism, pneumonia, pneumothorax, pericarditis/myocarditis, and Boerhaave’s syndrome. When the labs (including a troponin), an ECG, and chest x-ray yield normal results, questions often arise. Can you discharge her with a single troponin if she is low risk? How do you define low risk? And lastly, does she need urgent provocative testing after discharge?
Although umbilical catheterization can be a lifesaving technique in the emergent management of a critically ill neonate, it is performed infrequently in the ED.1 Simulation has emerged as a key teaching modality for residents to gain both proficiency and competency with this important procedure.2,3 Commercially available umbilical catheterization models are available, but costly, and often require an expensive investment (over $1,000 for a single trainer).4 This expense may discourage residency programs from acquiring the trainer and offering it to learners. In an effort to minimize this barrier to learning, a team from Kings County Hospital “home built” their own umbilical catheterization model. Their work was recently published in the Journal of Education and Teaching Emergency Medicine (JETem), and the ALiEM IDEA Series is proud to have recently teamed up with this journal to periodically share their innovations with our readership!
Accidental hypothermia is a life threatening condition that can lead to a challenging resuscitation. The very young, old, and intoxicated patient are at high risk to developing hypothermia, even in temperate climates. The pathophysiologic changes from hypothermia make the standard ACLS approach insufficient to care for the hypothermic patient. This article will discuss the physiology of hypothermia and how you should alter your approach in the hypothermic patient, including early consideration of extracorporeal membrane oxygenation (ECMO).
A bedside urine test for a pesticide is positive as shown in the photo. What pesticide is being detected?
Welcome to the Acute Coronary Syndrome (ACS) Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the AIR Team is proud to present the highest quality online content related to ACS emergencies. 13 blog posts within the past 12 months (as of July 2018) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 2 AIR and 11 Honorable Mentions. We recommend programs give 5.5 hours (about 25 minutes per article) of III credit for this module.
A 2-year-old previously healthy boy presents to the emergency department (ED) acting sleepier than usual. Yesterday, he was in his usual state of health, but this morning he didn’t wake up at his usual time of 6 am. When his father went to his room at 7 am, the child was lying in bed. He opened his eyes to look at his father, but did not get out of bed. The mother and father deny any trauma, fever, or seizure activity.