IDEA Series: A Low-fidelity Simulation Workshop for Teaching Cricothyroidotomy

The Problem

Cricothyroidotomy is an emergency life-saving procedure that involves surgical placement of a tube through the cricothyroid membrane in order to establish a patent airway for oxygenation and ventilation. The indications for this procedure are when traditional means, such as orotracheal or nasotracheal intubation, are contraindicated or have failed during attempts to establish an emergency airway.^1,2 It is a critical skill for emergency physicians but the declining rate of this procedure has resulted in decreased exposure during training.^3,4

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By Samuel Garcia|2019-03-28T21:25:08-07:00Feb 3, 2019|Critical Care/ Resus, IDEA series|

Trick of the Trade: Bubble Study for Confirmation of Central Line Placement

The safe placement a central venous catheter (CVC) remains an important part of caring for critically ill patients.¹ Over 5 million CVCs are placed each year in the United States. It is crucial to confirm that the central line is placed in the correct position in order to rule out potential complications of the procedure (e.g. pneumothorax) and begin administration of life-saving medications. Post-procedure chest radiographs (CXR) are the standard of care for CVC placements above the diaphragm. However, the annual cost to the U.S. healthcare system for CXRs after CVC placement is estimated to be over $500 million.² Further, in a busy ED, the limited availability of portable radiography may pose a considerable time delay. Radiography may also be limited in resource‐poor and austere settings, particularly the prehospital and military environments. We review a faster, cheaper, and more accurate alternative for evaluating CVC placement: point of care ultrasound (POCUS).

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By Timothy Montrief, MD MPH|2019-01-31T13:41:52-08:00Jan 31, 2019|Critical Care/ Resus, Tricks of the Trade, Ultrasound|

Influenza Update: IDSA 2018 Guidelines Detailed Review

Symptomatic influenza A and B infections cause worldwide morbidity and mortality every year. Annual vaccination remains the greatest prophylactic measure, but the vaccine is not 100% effective due to mismatch between the circulating and vaccine virus strains. Although most individuals will recover from influenza without incident, some specific patient populations are at high risk for severe complications. The Infectious Disease Society of America (IDSA) recently updated their clinical practice guidelines.¹ We review these key updates, including recommendations on who to test, treat, and provide chemoprophylaxis.

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By Jenny Koehl, PharmD, BCPS|2026-06-16T16:14:08-07:00Jan 28, 2019|Guideline Review, Infectious Disease, Public Health|

Significance of a traumatic pneumothorax or hemothorax found only on CT imaging

A 32 year old woman arrives in your emergency department after being in a motor vehicle collision where she was the seat-belted driver. She undergoes chest CT imaging despite a negative chest x-ray because of her ongoing anterior chest wall diffuse tenderness. You discover a small 10% pneumothorax (PTX), but no other associated thoracic injuries. Should you place a tube thoracostomy (chest tube)? Should this patient be admitted to the hospital? A 2019 Annals of Emergency Medicine paper by the NEXUS Chest research group tackles these questions.¹

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By Michelle Lin, MD|2019-03-28T21:36:39-07:00Jan 23, 2019|Expert Peer Reviewed (Clinical), Radiology, Trauma|

ACMT Toxicology Visual Pearls: Abnormal Brain Imaging

An 85 year-old man presented with coma after ingestion of a household product. Two key axial views of his brain MRI are shown. Which of the following did he ingest?

Apple cider vinegar
Bleach
Drain cleaner
Ethylene glycol
Hydrogen peroxide

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By Laura Tormoehlen, MD, FACMT, FAAN|2019-11-12T19:05:15-08:00Jan 21, 2019|ACMT Visual Pearls, Tox & Medications|

IDEA Series-JETem Innovation: A Low Cost Escharotomy Simulation Model for Residency Education

The Problem

Emergency Medicine (EM) residents are expected to be familiar with and competent in performing a wide number of procedures, including rare ones such as performing an escharotomy in a patient with severe burns. Unfortunately, there is a paucity of readily available simulation models to facilitate practice of this rare yet potentially life-saving skill.

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By Christopher Sampson, MD|2019-02-19T18:37:33-08:00Jan 19, 2019|IDEA series, Trauma|

SplintER Series: Hip Dislocation | Leg Day #2

Welcome to Leg Day #2 of the SplintER Series. Following up with the Leg Day #1’s primer on tibial plateau fractures, another key orthopedic injury of the leg is hip dislocation. A hip dislocation occurs when there is separation of the head of the femur from the acetabulum of the pelvis in either an anterior or posterior direction.¹

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By William Denq, MD CAQ-SM|2019-03-28T21:40:37-07:00Jan 14, 2019|Expert Peer Reviewed (Clinical), Orthopedic, SplintER, Trauma|