Trick of the Trade: A cleaner way to apply dental cement for a tooth fracture

$dental cement for tooth fracture$ The management of a dental fracture is a core skill of the emergency physician.¹ When the enamel is violated and the underlying dentin is exposed (i.e. Ellis Class II or greater), the dental pulp becomes at risk.² Protecting the exposed dentin in a timely manner, therefore, is paramount. This is best accomplished through the use of dental cements.

The application of dental cement to a fractured tooth, while a relatively rare procedure, is one often fraught with difficulties. With many of the formulations requiring the rapid application of a fast-drying cement, time for accurate and clean application is limited. This often clumsy, haphazard spackling of the patient’s tooth with cement rarely feels smooth or confidence-instilling. Isn’t there a better way?
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By Jason Hine, MD|2019-04-28T19:59:44-07:00Dec 29, 2016|ENT, Tricks of the Trade|

AIR-Pro: Toxicology (Part 2)

Welcome to the Toxicology (Part 2) AIR-Pro Module. Below we have listed our selection of the 12 highest quality blog posts related to 5 advanced level questions on toxicology topics posed, curated, and approved for residency training by the AIR-Pro Series Board. The blogs relate to the following questions:

One-pill-could-kill ingestions for pediatrics patients
Decontamination techniques
Physostigmine
Alcohol Withdrawal
High dose insulin therapy

In this module, we have 8 AIR-Pro’s and 4 Honorable Mentions. To strive for comprehensiveness, we selected from a broad spectrum of blogs identified through FOAMSearch.net and FOAMSearcher.

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By Fareen Zaver, MD|2018-01-30T02:50:54-08:00Dec 27, 2016|Approved Instructional Resources PRO (AIR-Pro Series), Tox & Medications|

PV Card: Elbow Injuries

Elbow injuries are a common presentation to the Emergency Department. This pocket card reviews some the imaging, acute management, and some pearls for the following injuries: elbow dislocation, radial head subluxation, supracondylar fractures (such as the xray on the right), radial head fracture, epicondylitis, condyle fractures, and olecranon fracture. Thanks to Dr. Jonathon Hancock (Doctor’s Hospital orthopedist) for the expert peer review.

PV Card: Elbow Injuries

View other PV Cards.

By Melody Glenn, MD|2021-10-02T19:08:45-07:00Dec 12, 2016|ALiEM Cards, Expert Peer Reviewed (Clinical), Orthopedic|

AIR Series: Infectious Disease Module (2016)

Welcome to the Infectious Disease 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 procedure content. Below we have listed our selection of the 18 highest quality blog posts within the past 12 months (as of August 2016) related to Infectious Disease emergencies, curated and approved for residency training by the AIR Series Board. More specifically in this module, we identified 2 AIRs and 16 Honorable Mentions. We recommend programs give 6 hours (about 20 minutes per article) of III credit for this module.

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By Andrew Grock, MD|2017-03-05T14:18:46-08:00Dec 1, 2016|Approved Instructional Resources (AIR series), Infectious Disease|

Ultrasound For The Win! Case – 40F with Fever, Chest Pain, Shortness of Breath

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real clinical case where point-of-care ultrasound changed the management of a patient’s care or aided in the diagnosis. In this case, a 40-year-old woman presents with a fever, chest pain, shortness of breath, cough, and generalized weakness.

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By Jeffrey Shih, MD, RDMS|2017-07-19T00:06:25-07:00Nov 28, 2016|Cardiovascular, Ultrasound, Ultrasound for the Win|

PV Card: LVAD Complications

Patients with left ventricular assist devices (LVAD) often cause much anxiety amongst providers in the emergency department. This is understandable with all of the hardware, diminished or absent peripheral pulses at baseline, and potential for complications. To add to the already helpful reviews about LVADs at REBELEM and emDocs, this is a PV card set providing a methodical approach to troubleshooting LVAD complications, including a reproduction of an algorithm for managing the LVAD patient with altered mental status from EMCrit.^1–3

[Download PDF]

EXPERT PEER REVIEW: LVAD Complications

John Greenwood, MD
Assistant Professor
Department of Emergency Medicine
Department of Anesthesiology and Critical Care
Hospital of the University of Pennsylvania | Perelman SOM

Overall, a very well written summary for the ED provider faced with the challenge of managing the patient with an LVAD. These patients can be very complex, where the clinician may need to address a range of potential problems that can include hemodynamic complications, coagulopathy & bleeding, arrhythmias, and infection. After you initially assess the patient, the most important step is to task someone to get a hold of the VAD coordinator as they will often be able to guide you through any recent device changes and previous complications. The patient’s family can provide a wealth of information – use them! Knowing the most common complications will help guide your HPI, exam, and interventions so that you are well prepared for the next time a VAD patient presents to your ED.

Thumbnail LVAD image use approved by Mayo Foundation for Medical Education and Research

References

Partyka C, Taylor B. Review article: ventricular assist devices in the emergency department. Emerg Med Australas. 2014;26(2):104-112. [PubMed]
Andersen M, Videbaek R, Boesgaard S, Sander K, Hansen P, Gustafsson F. Incidence of ventricular arrhythmias in patients on long-term support with a continuous-flow assist device (HeartMate II). J Heart Lung Transplant. 2009;28(7):733-735. [PubMed]
Greenwood J, Herr D. Mechanical circulatory support. Emerg Med Clin North Am. 2014;32(4):851-869. [PubMed]

By Nicolas Stadlberger, MD|2021-10-02T19:11:24-07:00Nov 23, 2016|ALiEM Cards, Cardiovascular, Critical Care/ Resus, Expert Peer Reviewed (Clinical)|

PV Card: Knee Injuries | Quick Reference Guide

Orthopedic injuries are commonly managed in the emergency department. Often a quick bedside reference card is needed to remind the clinician about the acute management decisions. This is the third of a series of orthopedic quick reference cards written by a team from the 2015-16 ALiEM Chief Resident Incubator. The first two were on ankle and hindfoot fractures and hip injuries. This card set covers knee injuries, specifically patella fractures, patella dislocation, and knee dislocation. These cards were expert reviewed by Dr. Scott Sherman, co-editor of the Emergency Orthopedics textbook (Amazon), and illustrations were created by Dr. Mary Haas.
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By Layla Abubshait, MD|2021-10-19T18:58:50-07:00Nov 21, 2016|ALiEM Cards, Orthopedic|

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