Ocular Ultrasound: Retinal Detachment and Posterior Vitreous Detachment
It’s 3 am in the middle of your busy night shift and you begin your evaluation of a 65 year-old woman with diabetes with several hours of unilateral flashes of light in her left eye. Her visual fields seem normal, but you are unable to see her fundus with your direct ophthalmoscope. Luckily, you remembered the teaching from your ultrasound rotation during residency. [+]
Trick of the Trade: Fist Bump to Reduce Pathogen Transmission
Handshaking has been practiced as far back as the 5th century BC and used today as a common way of greeting others. In the hospital setting this occurs multiple times throughout the day. Many alternatives to the handshake have been developed and utilized, but they have failed to replace the handshake as a form of greeting. Nosocomial infections have been identified as a major preventable complication of inpatient care and one of the most important initiatives to reduce this is hand hygiene. The authors of this study propose the fist bump as a safe and effective way to avoid hand-to-hand contact and therefore reduce transmission of infection. 1 [+]
Is the Patient Sober? Clinical Sobriety versus Blood Alcohol Concentration
There is significant practice variability when providers are asked to determine if a patient is intoxicated. Some providers will evaluate a patient to determine if a patient is “clinically sober”, while other providers will rely on a patient’s blood alcohol concentration (BAC) to evaluate a patient’s level of intoxication. There is very little data to suggest that either approach is superior; however, both practice patterns have significant limitations and carry a certain degree of medicolegal risk. [+]
Did you know that there are new Tox/Meds PV Cards?
Don’t know when to use ketofol for procedure sedation or if you can rapidly load phenytoin? See the new PV-Plus Cards on AgileMD for free on any smartphone/tablet/desktop. Other topics include: Thrombolytics for submassive PE Vasopressor agents for the hypotensive patients Tramadol t-PA for codes Searchable Emergency Drug Card with dosages for Adults and Pediatrics UPDATE Jan 1, 2018: The PV Cards are no longer on AgileMD.
Uncomplicated Urinary Tract Infection in Older Adults: Diagnosis and Treatment (Part 1)
It seems like a simple enough question: How do you diagnose and treat uncomplicated UTIs in older adults? The answer is: It depends. Part 1 of this post will discuss diagnosis of UTIs in this population, and part 2 will address treatment. [+]
Amylase Level for Pancreatitis: Stop doing it
A patient actively vomiting is wheeled into your ED. Within minutes IV access is obtained, and your nurse asks what tests and medicines are wanted. A liter of normal saline, ondansetron, and an H2 blocker are easy, but what labs to order? I think we can all agree on a metabolic profile to look at electrolytes and liver function tests, and a lipase level to assess for pancreatitis. But what about an amylase level? Originally from Clinical Monster blog [+]
New Cardiology PV Cards available on your phone and tablets!
After getting many requests for more PV cards, we are excited to launch 13 new topics located in the Cardiovascular folder of the Emergency Medicine: PV Cards collection on AgileMD. These new cards were made based off of blog posts from ALiEM’s authors. [+]
Blood Cultures in Pneumonia
A 75 year old woman is found to have pneumonia. With a CURB-65 of 3 and a PORT score of 95, she is correctly treated her for community acquired pneumonia with Ceftriaxone and Azithromycin, and admitted. Unfortunately, the admitting service points out that no blood cultures were drawn! What is the evidence for this? Originally from Clinical Monster blog [+]
Cyclobenzaprine vs TCA Toxicity
Should we treat a cyclobenzaprine (Flexeril) overdose similar to a tricyclic antidepressant (TCA) overdose? With the only difference between the commonly prescribed muscle relaxant, cyclobenzaprine, and the TCA amitriptyline consisting of a single double bond, should the emergency provider be concerned for life threatening arrhythmias in cyclobenzaprine overdose? [+]
When the PERC Rule Fails
Kline et al developed a clinical decision tool based on parameters that could be obtained from a brief initial assessment to reasonably exclude the diagnosis of pulmonary embolism (PE) without the use of D-dimer in order to prevent unnecessary cost and the use of medical resources. 1 Many of us have used the Pulmonary Embolism Rule-out Criteria (PERC) rule by now, but we should be clear on what it includes. Are we using it appropriately? [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Latest posts by Shuhan He, MD (see all)
- The Discharge Severity Index: Early Research on ED Readmission Risk Assessment - August 14, 2025
- Suboxone and the Emergency Physician: Get Waivered Training - August 12, 2022
- A Tale of Two Epidemics: COVID-19 and the Opioid Crisis - April 23, 2020