AIR Series: Psychiatry Module 2014

Welcome to the fifth ALiEM Approved Instructional Resources (AIR) Module! In an effort to reward our residents for the reading and learning they are already doing online we have created an Individual Interactive Instruction (III) opportunity utilizing FOAM resources for U.S. Emergency Medicine residents. For each module, the AIR board curates and scores a list of blogs and podcasts. A quiz is available to complete after each module to obtain residency conference credit. Once completed, your name and institution will be logged into our private database, which participating residency program directors can access to provide proof of completion.

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By Andrew Grock, MD|2017-03-05T14:14:15-08:00Dec 16, 2014|Approved Instructional Resources (AIR series), Psychiatry|

US4TW Case: 74F with Right Arm Tingling | Ultrasound for the Win series

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this peer-reviewed case series, we focus on real clinical cases where bedside ultrasound changed management or aided in diagnoses. In today’s case, a 74-year-old woman presents to the Emergency Department with painful right arm paresthesias.

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By Rob Bryant MD|2017-07-19T00:08:52-07:00Dec 15, 2014|Cardiovascular, Ultrasound, Ultrasound for the Win|

Esmolol Use in Cardiac Arrest

There is an abundance of sympathetic stimulation in patients who present in ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) whether endogenously released as a stress response or exogenously administered in a resuscitation attempt.¹ The hope is that sympathetic stimulation will increase the coronary and cerebral perfusion pressure of the patient and aid in resuscitation. However, there are numerous detrimental effects associated with epinephrine such as an increase in myocardial oxygen demand leading to increased ischemia.²

Contrary to traditional teaching, interesting evidence exists in both animal models as well as in limited reports in human subjects that show a potential benefit with beta blockade in cardiac arrest.

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By Jill Logan, PharmD BCPS|2016-12-19T10:52:53-08:00Dec 11, 2014|Cardiovascular, Critical Care/ Resus|

The Training of an EM Pharmacist

At the 2014 American College of Emergency Physicians Scientific Assembly, ACEP passed Resolution 44, officially recognizing Emergency Medicine Pharmacists as valuable members of the EM team. Nadia Awad (@Nadia_EMPharmD) summarized the importance of the resolution’s passage on the EMPharmD blog. The role of an EM Pharmacist has been outlined by the American Society of Health-System Pharmacists (ASHP). In addition, Zlatan Coralic (@ZEDPharm), one of ALiEM’s regular contributors, framed the EM Pharmacist as the ‘ultimate consult service.’ The intent behind this post is not to discuss the role of the EM Pharmacist, but to highlight the rigorous training process through which most EM Pharmacists have traversed to work in this amazing specialty.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2020-09-05T07:43:30-07:00Dec 9, 2014|Academic, Tox & Medications|

ALiEM-Annals of EM Journal Club: Satisfaction Scores and ED Analgesic Medications

This ALiEM-Annals of EM Global Journal Club features the Annals of EM journal club by Schwartz et al. entitled “Lack of Association Between Press Ganey Emergency Department Patient Satisfaction Scores and Emergency Department Administration of Analgesic Medications.” We hope you will participate in an online discussion based on the clinical vignette and questions below from now until Dec 5 2014. Please respond by commenting below or tweeting using the hashtag #ALiEMJC. In a few months, a summary of this journal club will be published in Annals of EM.

On Dec 4, 2014 at 1300 PST (1600 EST), we will host a live Google Hangout with the authors Drs. Tayler Schwartz and Kavita Babu.

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By Justin Hensley, MD|2017-07-15T12:31:51-07:00Dec 1, 2014|Journal Club, Tox & Medications|

Trick of the Trade: Pediatric video laryngoscope for ear foreign bodies

It is near the end of your shift and one of the nurses asks you to see a fellow ED staff member’s nine-year old daughter who has accidentally put a foreign body into her ear. You go see her and the otoscope reveals a small shiny jewel within the ear canal however flushing does not work to get it out. Next you try using the otoscope, while exposing the ear canal and holding the forceps to grasp the object. Unfortunately, it is difficult to get your assistant to align the light, and the otoscope speculum is limited in view and access.

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By Yen Chow, MD CCFP|2016-11-11T19:35:39-08:00Nov 26, 2014|ENT, Tricks of the Trade|

Can Permanent Marker Leach into IV Infusion Bags?

You are resuscitating a hypotensive patient with severe sepsis and have just hung your 4th liter of crystalloid. On the fluid bags, you wrote the numbers 1 through 4 in permanent marker to help keep track of your resuscitation. As you finish placing your central line the charge nurse enters the room. He informs you that according to the Institute for Safe Medical Practices (ISMP), writing directly on IV bags with permanent marker is not recommended due to concerns that the ink will leach into the bag and potentially cause harm to your patient.^1–4

This situation raises several questions: