A young man is brought into an emergency department after an electric lawn edger cut through his work boot and into the dorsum of his right foot. He has a clearly contaminated 5 cm x 1 cm laceration on the lateral side, and an underlying tendon is exposed. Sensation is diminished around the wound and he is unable to actively extend his 5th toe past a neutral position. How would you diagnose and repair his extensor tendon injury?
Robust and comprehensive studies now support specific management guidelines for patients presenting with different intracranial hemorrhages (ICH). From the Emergency Department perspective, the primary dilemmas involve specific blood pressure goals and whether seizure prophylaxis with phenytoin is necessary. The Brain Trauma Foundation provides an excellent summary of the current guidelines.1
Welcome to the Psychobehavioral 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 toxicology content. Below we have listed our selection of the 2 highest quality blog posts within the past 12 months (as of June 2017) related to psychology emergencies, curated and approved for residency training by the AIR Series Board. More specifically in this module, we identified 0 AIRs and 2 Honorable Mentions. We recommend programs give 1 hour (about 30 minutes per article) of III credit for this module. As of June 2017, the AIR series is now being used by over 125 residency programs with over 1,200 residents completing at least one module in the 2016-2017 academic year.
Welcome to the Renal/GU 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 Renal/GU content. Below we have listed our selection of the 13 highest quality blog posts within the past 12 months (as of May 2017) related to Renal/GU emergencies, curated and approved for residency training by the AIR Series Board. We identified 3 AIRs and 10 Honorable Mentions. We recommend programs give 4 hours (about 20 minutes per article) of III credit for this module. As of June 2017, over 125 residency programs are using the AIR series – that’s over 1,200 residents completing at least one module in the 2016-2017 academic year!
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High-quality chest compressions and early defibrillation are the cornerstones of effective cardiac arrest care.1 When implemented correctly these two interventions enhance patient outcomes and improve overall survival.2 However, despite simplified advanced cardiac life support (ACLS) algorithms and extensive training of providers, cardiac arrest scenarios in the emergency department (ED) are still high-stress and mortality rates remain high.3,4
Wound irrigation is arguably one of the most important steps in closing a laceration, because all lacerations should be considered to be contaminated. Irrigation is considered the foundation in preventing infection. A common way to cleanse a wound is to irrigate a wound using a 20 cc syringe, angiocatheter, and splash protector. To achieve 500 cc of irrigation, however, it would require 25 syringe refills! Is there a better, cost-effective alternative?
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The NIH Stroke Scale is used to assess the severity of a suspected stroke. It includes 11 neurologic exam components that can be quickly performed at the bedside. The second component of the NIH Stroke Scale is testing of voluntary horizontal eye movements, a.k.a., “best gaze”.1 Gaze is usually tested by instructing the patient to follow the examiner’s hand or pointer finger in a horizontal plane from side to side. This assessment assumes that the patient can comprehend instructions and actively participate in the physical exam.
But… how do you test gaze if your patient is aphasic or unable to follow commands?
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