Trick of the Trade: DIY Skyhook for Upper Extremity Swelling

A 25 year-old male presents to the ED complaining of left upper extremity pain, redness, and swelling. His cat bit him 2 days ago and his symptoms started today. On exam he has impressive induration, erythema, and warmth to the dorsum of the hand and forearm. He is neurovascularly intact and able to range his joints freely. In addition to IV antibiotics, you would like to keep his arm elevated while in the hospital. What is an easy and simple way help ensure that this patient keeps his arm elevated?
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By Luz Maria Silverio, MD|2018-05-29T10:36:07-07:00May 28, 2018|Orthopedic, Tricks of the Trade|

Climate Change and Emergency Medicine: A Specialty on the Frontline

Emergency medicine (EM) is on the frontlines of climate change, which the Lancet Commission declared “the biggest global health threat of the 21st century” with “potentially catastrophic risk to human health.”^1,2 Climate change is having broad and profound negative impacts on the health of our patients, especially for the vulnerable populations. It is also affecting our healthcare systems and mandating the creation of climate-resilient emergency departments (ED) with robust disaster preparedness. EM needs to engage climate change advocacy efforts for 2 key reasons. It has a profound impact on our specialty, and it is built into the moral fiber of our practice. As this threat continues to grow, EM is perfectly situated to lead the charge.
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By Renee Salas, MD MPH MS|2019-02-19T18:37:47-08:00May 15, 2018|Critical Care/ Resus, EMS, Environmental|

Ketamine for Severe Ethanol Withdrawal: A New Hope?

Ethanol withdrawal is a complex disease state. Two of the main players are GABA (an inhibitory neurotransmitter) and glutamate (an excitatory transmitter that can act on NMDA receptors). Simplistically, chronic ethanol use leads to a down-regulation of GABA receptors and an up-regulation in glutaminergic receptors, such as NMDA. When ethanol is abruptly discontinued, we are left with a largely excitatory state with less ability for GABA-mediated inhibition and more capacity for NMDA/glutamate-mediated excitation. While much of the treatment of severe ethanol withdrawal is focused on GABA, there are agents, such as phenobarbital and propofol, that can suppress the glutaminergic response. Ketamine seems like it should confer benefit, as well, due to its NMDA antagonist properties. Until recently there was only one clinical study using ketamine for severe ethanol withdrawal.¹ Now there are three.^2,3

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2018-05-15T04:39:17-07:00May 13, 2018|Tox & Medications|

ALiEM AIR Series: Ear, Nose, and Throat (ENT) Module

Welcome to the Ear, Nose, and Throat (ENT) 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 ENT emergencies. 8 blog posts within the past 12 months (as of December 2017) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 1 AIR and 7 Honorable Mentions. We recommend programs give 3 hours (about 20 minutes per article) of III credit for this module.
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By Andrew Grock, MD|2020-09-03T21:45:24-07:00Apr 12, 2018|ALiEMU, Approved Instructional Resources (AIR series), ENT|

ACMT Toxicology Visual Pearls: Spider Bite

A patient presents to the ED for management of a spider bite. Which of the following statements is correct regarding a bite from the spider pictured?

Laboratory studies can be helpful in management and predicting outcome.
Antibiotics are recommended.
The venom is cytotoxic and can cause red blood cell hemolysis.
The venom is more potent on a volume-per-volume basis than the venom of a pit viper.

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By Adrienne Hughes, MD|2019-11-12T19:06:33-08:00Apr 9, 2018|ACMT Visual Pearls, Tox & Medications|

Podcast Follow-up: Interview with Dr. Debbie Yi Madhok, Co-Author of “Update on the ED Management of Intracranial Hemorrhage”

Intracranial hemorrhage (ICH) is associated with significant disability and mortality. Although evidence-based guidelines exist, many hospitals have their own institutional practice patterns, which can make it difficult to care for these patients in the ED. Dr. Debbie Yi Madhok, an emergency physician and neurointensivist, sat down with Dr. Derek Monette, the ALiEM Deputy Editor in Chief, to discuss updates in the management of ICH. This interview follows up her original popular 2017 ALiEM post on dilemmas in ICH management, and takes a deeper dive into the nuances of seizure prophylaxis, blood pressure control, and platelet transfusions. We present the podcast and key learning points.
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By Debbie Yi Madhok, MD|2020-04-20T19:37:59-07:00Apr 6, 2018|Neurology, Podcasts, Tox & Medications, Trauma|

Herbal Induced Delirium: The Toxicologist Mindset

The Toxicologist Mindset series features real-life cases from the San Francisco Division of the California Poison Control System.

Case: A previously healthy 49-year-old woman presented to the emergency department (ED) with acute onset of confusion. Family members noticed her to have unsteady gait and she complained of blurry vision and difficulty urinating. She denied the use of any drugs or alcohol and took no medications. In the ED, her vital signs were: T 98.7, BP 95/59, P 130, RR 16, and O2 sat 100% on room air. Her pupils were 7 mm and reactive and her skin was dry. Bowel sounds were present. She had no focal neurological findings, but appeared “very confused” and “frightened.”

Serum electrolytes, CBC, and liver function tests were all unremarkable. She had a negative urine drug screen and alcohol level. The ECG demonstrated sinus tachycardia with normal intervals, and the brain CT was normal.

What are your next thought processes?

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By Craig Smollin, MD FACMT|2018-04-04T03:33:39-07:00Apr 4, 2018|Neurology, Tox & Medications|

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