Trick of the Trade: Don’t fight the ultrasound cord for peripheral IV access
Ultrasound-guided IVs require hand-eye coordination and fine movements of probe in Goldilocks fashion. Apply too much pressure, and the vein in question is compressed. Slide a little to the right, and now it's out of the window. Something that practitioners don't think about is the tension from the cord. If left to its own devices, the cord will tug on the probe, making the probe harder to steer and handle, especially for those tiny veins. Trick of the Trade: Reduce cord tension Have the patient grasp the cord! This makes them an active participant. Usually, if they are awake and [+]
PEM POCUS Series: Pediatric Appendicitis
Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric appendicitis. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit. Take the ALiEMU PEM POCUS: Pediatric Appendicitis Quiz Module Goals Describe the indications for performing point-of-care ultrasound (POCUS) for appendicitis Describe the technique for performing POCUS for appendicitis Recognize anatomical landmarks for POCUS for appendicitis Interpret signs of appendicitis on POCUS List the limitations of POCUS for appendicitis Case Introduction: Child with thigh pain Mason is an 8-year-old [+]
SplintER Series: Point Tender
A 42-year-old female presents to the emergency department with complaints of worsening finger pain. She reports the pain started 2 days ago with redness at the tip of the finger. Over the past 24 hours, her redness has spread and the finger has become more painful. On arrival, she is afebrile and hemodynamically stable. She has the below exam findings with tenderness along the volar aspect of the finger and pain with passive extension (Figure 1). What is your suspected diagnosis? What is your initial workup? What is your management and disposition? [+]
SplintER Series: Between a Rock and a Hard Place
A 17-year-old male basketball player presents with right lateral thigh pain for the past 3 weeks. He had a collision with another player 5 weeks ago that resulted in a bruise that has since resolved. He is mildly tender over the lateral mid-thigh in the soft tissues and has a decreased knee flexion. You obtain X-rays (Figure 1). What is your suspected diagnosis? What is your initial workup in the ED? What imaging confirms the diagnosis? What is your management and disposition? Figure 1: AP and lateral radiographs of the right femur [+]
ACMT Toxicology Visual Pearl | Substance-Induced Crystalluria: All That Glitters Is Not Gold
Which of the substances below causes crystalluria with hexagonal crystals that shimmer on macroscopic urine examination? Acyclovir Ethylene glycol Indinavir Primidone Sulfamethoxazole/trimethoprim [+]
Alex Ponce, PharmD
Indiana Poison Center
Latest posts by Alex Ponce, PharmD (see all)
PEM POCUS Series: Confirmation of Endotracheal Tube Placement
Read this tutorial on the use of point of care ultrasonography (POCUS) for confirmation of endotracheal tube (ETT) placement in pediatric patients. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit. Take the ALiEMU PEM POCUS: Pediatric ETT Confirmation Quiz Module Goals List indications for performing airway/lung POCUS to confirm ETT placement Describe the technique of performing airway and focused lung POCUS Distinguish between normal and abnormal airway and lung POCUS findings Distinguish between tracheal, endobronchial, and esophageal placement of ETT List [+]
Interpretation and Limitations of Opiate Urine Drug Tests
Background Urine drug tests are commonly sent for patients in the emergency department, however care should be taken when interpreting the results of these tests given their limitations. The American College of Medical Toxicology published a position statement on the interpretation of urine opiate and opioid tests [1]. In this publication, they outline many of the limitations of opioid urine drug tests and explain why they exist. Evidence Though often used interchangeably, the terms opiate and opioid are not the same. ‘Opioid’ is the broad category name while ‘opiate’ simply refers to the naturally occurring opioids. The term ‘opioid’ encompasses [+]
Should Diphenhydramine be included in an Acute Agitation Regimen?
Background Acute agitation in the emergency department is a common issue that frequently requires the use of chemical sedation to preserve safety for patients and healthcare workers. A commonly employed treatment regimen is the combination of haloperidol 5 mg + lorazepam 2 mg + diphenhydramine 50 mg (B-52). Diphenhydramine is included in this treatment regimen primarily to prevent extrapyramidal symptoms [1,2]. However, the incidence of extrapyramidal symptoms (EPS) with haloperidol is quite low when treating agitation in the emergency department (ED) [3,4]. Therefore, the excessive and prolonged sedation from adding prophylactic diphenhydramine may outweigh the intended benefit and should be [+]
PEM POCUS Series: Pediatric Ultrasound-Guided Fascia Iliaca Block
Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric fascia iliac block. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit. Take the ALiEMU PEM POCUS: Pediatric Fascia Iliac Block Quiz Module Goals List indications of performing a pediatric point-of-care ultrasound fascia iliaca nerve block (POCUS-FINB) List the limitations of POCUS-FINB Describe the technique for performing POCUS fascia iliaca nerve block Identify anatomical landmarks accurately on POCUS Calculate the maximum safe weight-based local anesthetic dose Recognize the [+]
ACMT Toxicology Visual Pearl: Hypertension and Rash
Which toxic exposure can present with the pictured rash along with hypertension and tachycardia mimicking pheochromocytoma? Arsenic Lead Mercury Silver Thallium [+]
Michael Semple, DO
Washington University School of Medicine
Latest posts by Michael Semple, DO (see all)
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)
- 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
- Teaching in the age of COVID-19: Enhancing discussion with digital asynchronous chats - March 18, 2020