First ALiEM journal article: Trial of void for acute urinary retention

A patient may present to the ED after foley catheter placement for acute urinary retention (AUR) a few days ago and now requests catheter removal. Ideally this should be performed in the urologist’s office. However, occasionally patients cannot or do not follow up with the urologist in a timely manner and return to the ED expecting urethral catheter removal. A careful history and physical should be performed along with a consulting urologist. If the eventual decision is to remove the urethral catheter in the ED, what is important to know about a Trial of Void (TOV)?

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By Javier Benitez, MD|2018-01-30T01:58:58-08:00Mar 19, 2013|Genitourinary|

Patwari Academy videos: Respiratory failure and ventilators

Dr. Rahul Patwari reviews the basics of respiratory physiology, the pathophysiology behind respiratory failure, and ventilator management. What do all the ventilator settings mean?

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By Michelle Lin, MD|2019-01-28T22:00:36-08:00Mar 17, 2013|Patwari Videos, Pulmonary|

Is it time to trash the stethoscope? The age of ultrasound

Is the physical exam a relic of the past, because our tools are relics of a prior era?

It is important to do and teach a thorough physical exam. I cautioned against the overreliance on diagnostic testing in lieu of a physical exam, which can be initially burdensome and prolonged. But perhaps our difficulty with the physical exam is not the exam itself, but the tools that we have at our disposal to perform an exam, rather than the exam itself.

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By Nikita Joshi, MD|2018-01-30T01:59:00-08:00Mar 15, 2013|Medical Education, Ultrasound|

What’s the Code Dose of tPA?

Suppose you have a patient in whom you highly suspect a pulmonary embolism (PE) that devolves into PEA arrest while awaiting a CT angiogram. Or, what about a patient with an ECG showing clear STEMI that loses pulses?

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2018-02-17T01:56:47-08:00Mar 14, 2013|Tox & Medications|

Lytics for sub-massive PE: Ready for primetime?

There was recently a great study published in the American Journal of Cardiology (2012) by Sharifi et al¹, questioning whether we should be considering tPA in patients other than those patients with massive pulmonary embolism (PE)? You know the big “Saddle Embolus” we all fear? Well it turns out this is only about 5% of all PEs.

Should we be considering tPA in patients with sub-massive PEs?

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By Salim Rezaie, MD|2019-09-10T13:37:21-07:00Mar 13, 2013|Cardiovascular, Pulmonary, Tox & Medications|

Patwari Academy videos: Chest trauma

In the third and fourth video in the Trauma series (first two videos = primary and secondary survey), Dr. Rahul Patwari discusses about chest trauma, divided into blunt and penetrating mechanisms. What is “the box” that everyone keeps referring to?

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By Michelle Lin, MD|2019-01-28T22:04:15-08:00Mar 10, 2013|Patwari Videos, Trauma|

PE in pregnancy: which diagnostic tests do you use?

Pulmonary embolism (PE) can be a deadly disease and one of the most challenging diagnosis to make in a pregnant patient. Patients may present with signs and symptoms that might also be present in a normal uncomplicated pregnancy. Even in nonpregnant patients, the diagnosis of venous thromboembolism (VTE) such as PE can be quite challenging.

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By Javier Benitez, MD|2026-06-16T16:01:58-07:00Mar 6, 2013|Cardiovascular, Ob/Gyn, Pulmonary|