PEM Pearls: Perfecting your pediatric lumbar puncture using ultrasound

A lumbar puncture (LP) is a common procedure that every emergency physician must master. Pediatric LPs can be challenging for even the most experienced clinician due to small anatomy, difficulty with patient cooperation, and lack of frequency performed. A successful procedure is defined by obtaining cerebrospinal fluid and/or performing a non-traumatic lumbar puncture. There are multiple variables that lead to a successful pediatric lumbar puncture including provider experience, use of anesthesia, and patient positioning. Success rates for pediatric lumbar punctures are variable, with a large range from 34%-75%.¹

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By Ashley Foster, MD|2017-10-26T14:33:32-07:00Sep 21, 2016|CME, Pediatrics, PEM Pearls, Ultrasound|

AIR Series: Procedures Module (2016)

Welcome to the Procedures 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 13 highest quality blog posts within the past 12 months (as of June 2016) related to procedure emergencies, curated and approved for residency training by the AIR Series Board. More specifically in this module, 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.

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By Andrew Grock, MD|2017-03-05T14:18:45-08:00Sep 12, 2016|Approved Instructional Resources (AIR series), Critical Care/ Resus|

Trick of the Trade: Simple finger traps using gauze roll

Closed reduction of fractures or dislocations in the hand and wrist can be difficulty to achieve. Gravity can serve as an assistant. Commercial finger traps are available, but can sometimes be hard to find in the Emergency Department. An earlier trick of the trade describes the use of a gauze role to build your own finger trap setup. The following describes a simpler way to build finger traps using a gauze roll.

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By Juan Carlos Montoy, MD PhD|2016-10-26T17:04:16-07:00Sep 1, 2016|Orthopedic, Tricks of the Trade|

‘Treat and Release’ after Naloxone – What is the Risk of Death?

Often in the prehospital setting, naloxone is administered by EMS (or possibly a bystander) to reverse respiratory and CNS depression from presumed opioid overdose. The patient then wakes up, and not uncommonly, refuses transport to the hospital. The question is: Is it safe to ‘treat and release?’ Or, rather, what is the risk of death associated with this practice.

Last updated: January 2, 2019

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2020-04-20T19:47:14-07:00Aug 24, 2016|Podcasts, Tox & Medications|

Trick of the Trade: Paraphimosis – Pour Some Sugar On Me

Paraphimosis occurs when a retracted foreskin can’t be reduced back over the glans of the penis. Risk factors for paraphimosis include scarring, vigorous sexual activity, chronic balanoposthitis, and forgetting to replace the foreskin after catheterization or manipulation.

Paraphimosis can be a urological emergency as the tight ring formed by the foreskin can cause ischemia to the tip of the penis and eventually gangrene. Timely reduction is of high importance. Treatment involves gentle compression of the glans and gradual manual foreskin retraction.¹ Unfortunately, as time goes on, more swelling occurs making traditional reduction techniques more difficult.

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By Jonathan Fu, MD|2018-01-30T02:45:23-08:00Aug 22, 2016|Genitourinary, Tricks of the Trade|

Trick of the Trade: Ear Irrigation in the Emergency Department

Ear irrigation is an important tool for adult and pediatric patients in the Emergency Department (ED) with ENT complaints. Irrigation can be used to clear ear cerumen, visualize tough-to-see tympanic membranes, and remove foreign bodies. This may reduce the need for subspecialist care and improve the patient’s hearing and quality of life.¹ Commercial electronic and mechanical devices are available for irrigation and have been studied. Moulton and Jones presented the improved efficacy of foreign body removal using an electric ear syringe in an (ED) population.² In this trick of the trade, we present a low cost and effective way of “ear-rigation” taught to us by one of our veteran nurses using easily available tools in the ED.

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By Chris Belcher|2016-11-11T19:47:00-08:00Aug 18, 2016|ENT, Expert Peer Reviewed (Clinical), Tricks of the Trade|

Diagnose on Sight: Case of a red, swollen neck

Case: A 78 year-old female with a past medical history of asthma and hypothyroidism presents with a three day history of sore throat and a two day history of a “lump” along the right side of her neck. The “lump” has now progressed to involve both sides of her anterior neck and is accompanied with erythema, tenderness to palpation, and swelling. In addition, the patient has developed a hoarse voice and odynophagia. The patient’s primary care physician referred her to an ENT specialist, who then referred the patient to the ED for urgent imaging due to the concern for a deep space neck infection. Triage vitals are remarkable for a heart rate of 118 beats per minute. She is otherwise normotensive and afebrile. On physical exam, slight crepitation in noted on the floor of the patient’s mouth. Of note, the patient also informs you of her penicillin allergy. Which of the following is the biggest risk factor for this particular disease process?

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By Shyam Sivasankar, MD|2016-12-22T19:19:10-08:00Aug 17, 2016|Diagnose on Sight, ENT|

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