SplintER Series: Common ED Splint Techniques 104

The SplintER series is back with its fourth installment! In this series, we review splinting fundamentals, introduce advanced concepts, and highlight ways to implement these into your next shift. In this post, we summarize some of the most commonly deployed splints in the ED. Peer-reviewed by sports medicine experts (Dr. Kori Hudson and Dr. Anna Waterbrook), these injury-splint summary tables provide information on the origin, insertion, and positioning for each splint, along with the recommended number of layers of plaster.
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By William Denq, MD CAQ-SM|2020-08-08T15:17:38-07:00Jul 4, 2018|SplintER|

ACMT Toxicology Visual Pearls: Snake Bite

Envenomation by the pictured snake would be expected to produce which clinical effects?

Bradycardia and hypotension
Bruising and epistaxis
Difficulty swallowing and muscle weakness
Severe swelling and blistering

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By Patricia Rosen, MD, MPH|2019-11-12T19:06:17-08:00Jun 26, 2018|ACMT Visual Pearls, Environmental, Tox & Medications|

Welcome to the Endocrine Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to Endocrine emergencies. 8 blog posts within the past 12 months (as of May 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 6 Honorable Mentions. We recommend programs give 3 hours (about 20 minutes per article) of III credit for this module.
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By Chris Belcher, MD|2020-09-04T10:58:13-07:00Jun 20, 2018|ALiEMU, Approved Instructional Resources (AIR series), Endocrine-Metabolic|

PEM Practice Changing Paper: Clinical Trial of Fluid Infusion Rates for Pediatric DKA

Most protocols for managing pediatric patients with diabetic ketoacidosis (DKA) are based on a theoretical association between fluid resuscitation and subsequent neurological decline. Although the evidence for an association between IV fluids and cerebral edema comes from retrospective reviews, for over 20 years, it is an accepted teaching principle of pediatric DKA.

Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis, published just days ago in the New England Journal of Medicine, challenges this teaching with the first randomized controlled trial designed to investigate the relationship between IV fluids and cerebral edema. We review this publication and present a behind-the-scenes podcast interview with lead authors Dr. Nathan Kuppermann and Dr. Nicole Glaser from the Pediatric Emergency Care Applied Research Network (PECARN). (more…)

By Derek Monette, MD|2021-07-01T21:14:43-07:00Jun 15, 2018|Critical Care/ Resus, Endocrine-Metabolic, Neurology, Pediatrics|

The Myth of Vasopressors and Ischemia

Despite the widespread clinical use, and their well-documented life-saving properties, vasopressors are often maligned, accused of causing ischemia to fingers, toes, mesentery, kidneys, and so forth. Not only is the evidence that this happens poor, but, a fear of this dreaded complication can unwarrantedly lead good clinicians to limit or withhold potentially life- and organ-saving medications. This article showcases the importance of end-organ perfusion and explains how vasopressors may in fact be one of the most important therapies in an emergency physician’s armamentarium.
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By Susan Wilcox, MD|2018-06-11T08:02:01-07:00Jun 11, 2018|Critical Care/ Resus, Tox & Medications|

The Problem

Emergency ultrasound (EUS) has quickly become a fundamental aspect of emergency medicine (EM) residency training. While still relatively novel to the field, there has been a significant focus on curriculum development in accordance with the core ultrasound application guidelines set forth by the American College of Emergency Physicians (ACEP).¹ Currently, there is no consensus on the optimal approach to EUS education that will provide learners with true clinical competence post-matriculation. Furthermore, a recent survey demonstrated that there is conflict between what ACEP guidelines consider to be competence in EUS and resident opinion on the matter.² One potential identified issue with our current model is the focus on early ultrasound learning in junior EM residents with a lack of ongoing EUS education in senior years.
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By Michael Macias, MD|2018-06-06T09:33:25-07:00Jun 10, 2018|IDEA series, Ultrasound|

Trigger Point Injection for Musculoskeletal Pain in the ED

Musculoskeletal pain is a common ED presentation and emergency providers can often manage it with NSAIDs alone.¹ On the other hand, when patients present with small localized areas of intense muscle spasm called trigger points, NSAIDs won’t cut it. A trigger point injection (TPI), however, is a safe and easy way to treat the underlying cause of trigger point pain, and requires only basic equipment already available in most the EDs.