ALiEM-Annals of EM Journal Club: Clinical Decision Rule for Subarachnoid Hemorrhage

We are very excited this month to bring you our second Global Journal Club, co-hosted by the team here at ALiEM and the editorial board at the Annals of Emergency Medicine. This month, we are changing things up! We will be providing you, our readers, with a clinical vignette and related journal club questions today at the beginning of the week.The discussion will be held asynchronously starting today through Thursday (for 4 days). Respond by blog comment below or tweet (#ALiEMJC).

On Wednesday, January 22, 2014 at 11 am PST (2 pm EST), we will be hosting a 30-minute live Google Hangout with Drs. Jeff Perry and Ian Stiell. The video will be embedded on this page. During this period, you will be able to tweet by using the #ALiEMJC hashtag and post comment in the blog comment section below.

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By Teresa Chan, MD, MHPE|2026-06-16T16:04:51-07:00Jan 20, 2014|Journal Club, Neurology|

Should We Admit All Patients with Sternal Fractures?

The detection rate of sternal fractures following motor vehicle collisions and blunt trauma to the chest and abdomen has increased over the past decade. The reason for this increase is most likely from the use of seat belts and better imaging modalities such as computed tomography (CT) in trauma patients. I can recall as a resident being told that any patient with a sternal fracture should be admitted to trauma because of the high likelihood of blunt cardiac injury and high mortality rate associated with this injury, but is this always true?

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By Salim Rezaie, MD|2026-06-16T16:04:38-07:00Jan 17, 2014|Cardiovascular, Trauma|

Approach to Difficult Vascular Access

Intravenous (IV) access is a basic and invaluable skill for emergency physicians. For patients requiring rapid fluid resuscitation, airway management, or medication administration, the placement of one or more IV lines is absolutely essential. Most patients do well with a simple, landmark-based, blind placement of a superficial peripheral IV. However, we often encounter situations where this may be difficult or impossible to achieve, and so we all should have a repertoire of other sites and techniques to employ.

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By Terrance Lee, MD|2026-06-16T16:04:43-07:00Jan 15, 2014|Cardiovascular, Critical Care/ Resus, Expert Peer Reviewed (Clinical)|

Applying to EM-Critical Care Medicine Fellowships: What you need to know

Emergency physicians (EPs) have been successfully training in and practicing critical care in the ICU for decades, though until recently board certification remained closed to EPs. In the last few years, however, we have seen monumental changes in training opportunities for EPs, including national standardization of training programs, and most importantly, the establishment of three distinct pathways to board certification. Though the details of some of these pathways are still being worked out, much more concrete arrangements have been reached in the last 6 months. If you are an EM resident interested in applying to critical care fellowships, this is what you need to know.

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By Julian Villar, MD MPH|2026-06-16T16:04:41-07:00Jan 14, 2014|Critical Care/ Resus, Medical Education|

The HEART Score: A New ED Chest Pain Risk Stratification Score

Chest pain is a common presentation complaint to the emergency department (ED) and has a wide range of etiologies including urgent diagnoses (i.e. acute coronary syndrome (ACS), pulmonary embolism, aortic dissection) and non-urgent diagnoses (i.e. musculoskeletal pain, gastroesophageal reflux disease (GERD), pericarditis). The challenge in the ED is to not only to identify high risk patients but also to identify patients who can be safely discharged home. Specifically, when dealing with ACS, dynamic ECG changes or positive cardiac biomarkers is pretty much a slam dunk admission in most cases, but a lack of these does not completely rule out ACS. Currently, most guidelines and risk stratification scores focus on the identification of high risk ACS patients that would benefit from early aggressive therapies, but what about all the other chest pain patients that don’t have ACS… are they accounted for?

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By Salim Rezaie, MD|2019-09-10T13:35:00-07:00Jan 7, 2014|Cardiovascular|

Tramadol: When to avoid it

Tramadol is a popular agent for the treatment of pain and offers an alternative to opioid therapy. Tramadol exerts its analgesic effects through weak stimulation of the mu opioid receptor as well as inhibiting the reuptake of serotonin and norepinephrine similar to some antidepressant medications. While tramadol may be an effective option for mild to moderate pain in otherwise healthy individuals, the following patients may benefit from an alternative analgesic selection. ^1–4

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By Jill Logan, PharmD BCPS|2016-11-11T19:18:03-08:00Jan 6, 2014|Tox & Medications|

New Year’s Resolution: Let’s Dose Vancomycin Correctly in the ED

Vancomycin remains one of our workhorse antimicrobials for treating infections caused by methicillin-resistant S. aureus
(MRSA). As the incidence of MRSA infections continues to rise AND we are starting to see increasing minimum inhibitory concentrations (MIC) with vancomycin, it is paramount that we optimize its use, starting in the Emergency Department (ED).

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2016-11-17T08:31:54-08:00Jan 1, 2014|Tox & Medications|