Sepsis in Older Adults: The Presentation May Be Subtle
60% of patients in the United States who develop severe sepsis are older adults (age 65 and over) [1], and the mortality of severe sepsis increases steadily with age to nearly 40% in those over 85 [2]. There are many factors that make older adults more susceptible to sepsis, and that can also make sepsis more difficult to detect. Here are some tips to help explain why this is, and how you can identify it sooner. [+]
PV Card: Focused Lung Ultrasound
Bedside pulmonary ultrasonography is becoming increasingly popular in the Emergency Department. You can you use it to assess for pneumothoraces, pleural effusion, pneumonia, pulmonary edema, and other etiologies. There are subtle nuances to help you differentiate these diagnoses. What are A-lines and B-lines? This PV card on the focused lung ultrasound by Drs. Anne Aspler, Clare Heslop, and Mike Stone outline some great bedside tips. PV Card: Focused Lung Ultrasound Adapted from [1–3] References Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005;12(9):844-849. [PubMed] Liteplo A, Marill [+]
PV Card: Pericarditis – Diagnosis and Treatment Recommendations
When the topic of pericarditis is mentioned, the classic electrocardiogram (ECG) findings of diffuse ST elevation and PR depression are often the focus of discussion. What about the criteria for diagnosis, the 3-prong approach to treatment, and contraindications to colchicine? These are the great questions answered by Dr. Chris Bond (@socmobem) in this PV card, which summarize 3 key papers by Imazio et al from the New England Journal of Medicine, Archives of Internal Medicine, and Circulation. PV Card: Pericarditis - Diagnosis and Treatment Read more ALiEM (PV) Cards.
PV Card: Focused Ocular Ultrasound
Ocular injuries and pathology are a common cause for Emergency Department visits. With bedside ultrasonography, many of these conditions can be assessed. Did you know that you can check for a retinal detachment, vitreous hemorrhage, and even a lens dislocation? What do these look like? Check out this great PV card on the focused ultrasound assessment of the eye. PV Card: Ocular Ultrasound Adapted from [1, 2] Go to ALiEM (PV) Cards for more resources. References Blaivas M, Theodoro D, Sierzenski P. A study of bedside ocular ultrasonography in the emergency department. Acad Emerg Med. 2002;9(8):791-799. [PubMed] Kimberly H, [+]
Diagnose on Sight: Traumatic low back pain
Case: An 18 year old female was the restrained passenger in a motor vehicle crash moving at 65 mph. She complained of traumatic low back pain radiating to her abdomen. What is the most likely mechanism of injury, based on this video of CT images? [+]
Anti-NMDA-Receptor Encephalitis
Anti-NMDA-receptor encephalitis is a severe and treatable immune-mediated disorder which presents with a rapid progression of psychiatric and neuropsychiatric symptoms. Although only first reported as a diagnosis in 2007, an exponential number of cases have since been described, suggesting that the disease is not rare but rather under-diagnosed. Emergency physicians play an important role in recognizing this disorder, as prognosis is largely dependent on early treatment with immunotherapy. [+]
PV Card: Testicular Ultrasound for Torsion and Epididymitis
"Time is testicle." Every minute drags by while you are awaiting your ultrasonographer to arrive to scan your patient to rule out testicular torsion. Why not take a quick look yourself? What are you looking for? This is an excellent PV card by Drs. Matthew Dawson and Mike Stone on the topic of testicular ultrasound, giving the basics about testicular torsion and acute epididymitis. PV Card: Testicular Ultrasound Adapted from [1, 2] Go to ALiEM (PV) Cards for more resources. References Blaivas M, Sierzenski P. Emergency ultrasonography in the evaluation of the acute scrotum. Acad Emerg Med. 2001;8(1):85-89. [PubMed] Blaivas M, Sierzenski P, [+]
Must-Know EM Pharmacotherapy Articles of 2014
There is so much literature to sift through each year, it becomes nearly impossible to stay abreast of it. Here is a quick summary of the 6 must-know Emergency Medicine pharmacotherapy articles from 2014, in my humble opinion. [+]
ALiEM Bookclub: Brain on Fire – My Month of Madness
“Looking back at this time, I see that I’d begun to surrender to the disease, allowing all the aspects of my personality that I value – patience, kindness, and courteousness – to evaporate. I was a slave to the machinations of my aberrant brain. We are, in the end, a sum of our parts, and when the body fails, all the virtues we hold dear go with it.” – Brain on Fire, Susannah Cahalan [+]
Trick of the Trade: Knee Arthrocentesis
A patient comes into the ED and you suspect septic arthritis to the knee. As you consent the patient for arthrocentesis, you can tell s/he has reservations about a needle being inserted into their knee and left in place while you aspirate. You also think in the back of your mind how tricky it is to sometimes change syringes while keeping the needle in the correct location. Is there another way of tapping the knee without a needle? [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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