ALiEMU School Doors Open – Featuring the CAPSULES Series

Our virtual school doors are open starting today to ALiEM University (ALiEMU), which can best be thought of as our open-access, on-demand, online school of e-courses for anyone practicing Emergency Medicine worldwide. This ambitious venture was made possible by a tremendous team, but primarily led by Chris Gaafary, MD (@CGaafary), ALiEMU’s Chief of Design and Development and an EM chief resident in his free time at the University of Tennessee. Today we are incredibly excited to launch our inaugural longitudinal e-course the ALiEM Capsules Series: A Practical Pharmacology for the EM Practitioner, created and led by Bryan Hayes, PharmD, FAACT (@PharmERToxGuy).

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By Michelle Lin, MD|2019-11-10T21:51:17-08:00Jul 13, 2015|ALiEMU, Capsules, Medical Education, Social Media & Tech, Tox & Medications|

Trick of the Trade: DIY Circulating Water Bath for Frostbite Treatment

A 26-year-old woman presented to an urban Detroit emergency department complaining of bilateral foot pain after walking outside in the snow for 30 minutes without shoes or socks. She was unable to ambulate secondary to the pain and swelling. Physical examination revealed bilateral pallor, doughy texture, and coolness to the touch. There was generalized tenderness to palpation throughout the digits. The overlying skin was edematous, although without signs of breakdown.

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By Ciara Barclay-Buchanan, MD|2018-01-30T02:28:16-08:00Jul 8, 2015|Environmental, Expert Peer Reviewed (Clinical), Tricks of the Trade|

Trick of the Trade: DIY Finger Traps

Distal radius fractures are among the most commonly encountered fractures in the emergency department (ED). They have been reported to account for around 25% of pediatric fractures and up to 18% of fractures in the elderly.¹ Reducing minimally displaced distal radius fractures is a procedure that can be greatly facilitated by the presence of finger traps, which help hold traction while you reduce the fracture.² Often While working in small 5-bed, free-standing emergency department (ED), I found myself needing to perform this vital procedure and finger traps were unavailable.

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By Jailyn Avila, MD, RDMS (She/Her)|2024-02-22T14:29:56-08:00Jul 1, 2015|Orthopedic, Tricks of the Trade|

Blast From the Past: Occult Sepsis, Lactic Acid, and Mortality

Severe sepsis and septic shock affect millions of patients worldwide and have high rates of morbidity and mortality as well as high resource utilization. The way we manage sepsis has changed quite a bit since the Rivers et al randomized controlled trial of early goal-directed therapy (EGDT) ¹ , which had an absolute decrease in mortality from 46% with “usual care” to 31% with EGDT. What we now know is that a proactive approach to septic patients will result in lower mortality rates and better outcomes (i.e. early identification, early intravenous fluids, and early antibiotics). Patients with sepsis are still missed despite the fact that we understand the benefits to morbidity and mortality with early recognition. In this blast from the past study from 2007, Howell et al ² answered the important question of does elevated lactic acid simply reflect a patient’s hemodynamic status or can it independently predict 28 day in-hospital mortality after controlling for other potential confounders in patients with sepsis. (more…)

By Salim Rezaie, MD|2016-11-11T19:37:14-08:00Jun 29, 2015|Critical Care/ Resus, Expert Peer Reviewed (Clinical), Infectious Disease|

Introducing the New ALiEMU Capsules Series

We are excited and proud to introduce a new series as part of the recently announced ALiEMU: Capsules: Practical Pharmacology for the EM Practitioner.

The Capsules series’ primary focus is bringing Emergency Medicine pharmacology education to the bedside. Our expert team distills complex pharmacology principles into easy-to-apply concepts. It’s our version of what-you-need-to-know as an EM practitioner. We hope you enjoy it.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2026-06-16T16:06:52-07:00Jun 22, 2015|Capsules, Medical Education, Social Media & Tech, Tox & Medications|

AIR Series: Respiratory Part 1 (2015)

We found an enormous amount of posts on respiratory topics and thus have divided the content into two modules. This first module will focus on general respiratory issues with airway and pulmonary embolism covered in the second module. Below we have listed our selection of the 15 highest quality blog posts within the past 12 months (current as of April 2015) related to respiratory, curated and approved for residency training by the AIR Series Board. In this module we have 4 AIRs and 11 Honorable Mentions. We strive for comprehensiveness by selecting from a broad spectrum of blogs from the top 50 listing per the Social Media Index.

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By Andrew Grock, MD|2026-06-16T16:07:30-07:00Jun 17, 2015|Approved Instructional Resources (AIR series), Pulmonary|

Salicylate Toxicity PV card v2: Lessons in post-publication review

I was recently the author of a PV card for management of Salicylate Toxicity, which had some discrepancy with expert opinion. The point of contention was in regards to measurement of urine pH vs serum pH for alkalinization. In preparing the first version of the card, I began with notes from a recent toxicology rotation, and expanded by examining textbooks and review articles. Although there was mention of serum pH measurement, numerous sources emphasized urine alkalinization as the primary endpoint for the treatment of aspirin toxicity. Therefore I choose to include this on the size-limited PV card.

Despite review by numerous peers and colleagues, not long after publication we were met with concern from prominent toxicologists regarding an oversight in mentioning serum alkalinization. Utilizing the strengths of our blog and social media we were immediately able to initiate a discussion with experts on the topic.

Expert Peer Review Comments

Dr. Lewis Nelson of NYU was able to clarify that by prioritizing serum alkalinization, we will avoid the cerebral toxicity that is the primary etiology of mortality. Serum alkalinization should also facilitate urine alkalinization as well as allow time to arrange for hemodialysis. Dr. Bram Dolcourt from Detroit expanded that serum alkalinization and normokalemia alone do not guarantee an optimal urine pH and suggest measurement of both urine and serum. From Twitter, Dr. David Juurlink from Toronto also recommended measurement of both, stating his forthcoming publication will expand on the topic. Our own ALiEM clinical pharmacist Dr. Bryan Hayes also assisted with expert insight as I was revising the PV card.

My Reflections

As the ALiEM-CORD virtual fellow, I have had the challenging task of collaborating with experts in my field, while still very much in a learner role myself. I was fortunate enough to have been featured on a site that has a robust commenting system and pride in peer review, even if it is post-publication. There is certainly content on the web that may be inaccurate or ‘less-accurate’, and consumers of both FOAM and conventional publications, as always, should remain critical and review multiple sources. There is a broad range in teaching and practice based on region, and when we work together we can identify what is truly best practice. Hopefully this conversation and the forthcoming publication on the topic will translate into changes in practice and in the textbooks in the coming years. Luckily, utilizing the strengths of our medium, we are able to publish these corrections today.

PV Card: Acute Salicylate Toxicity

For those curious, here was the original version 1.

By Sam Shaikh, DO|2021-10-05T12:51:20-07:00Jun 15, 2015|ALiEM Cards, Expert Peer Reviewed (Clinical), Medical Education, Social Media & Tech, Tox & Medications|