ALiEMU AIR Obstetrics and Gynecology Module

By |Categories: ALiEMU, Approved Instructional Resources (AIR series), Ob/Gyn|

Welcome to the Obstetrics and Gynecology (Ob/Gyn) 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 online content related to Ob/Gyn emergencies. 10 blog posts within the past 12 months (as of July 2018) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 2 AIR and 8 Honorable Mentions. We recommend programs give 4 hours (about 25 minutes per article) of III credit for this module. […]

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Ultrasound guided peripheral IV: It’s time to clean up our act

By |Categories: Infectious Disease, Ultrasound|

Have you ever performed a procedure, when suddenly, you are overcome by a sinking feeling that something just is not right? A mix of fear, guilt, and anger: Fear that you endangered a patient, guilt that you missed an important step in the procedure, and anger at yourself for being careless. The oath we take as physicians echoes loudly: Primum non nocere. First, do no harm. […]

EM Fellowship Match Advice: Ultrasound Fellowship

By |Categories: EM Match Advice, Ultrasound|

The EM Residency Match Advice Series is back with its latest installment! We put the focus on emergency ultrasound fellowships, and our sage panel walks us through some of the changes to this year’s application cycle. For the first time, Ultrasound Fellowship Programs will participate in the NRMP match program. The Society for Clinical Ultrasound Fellowships (SCUF) provides the fellowship application service (similar to the role of ERAS, but shorter!) for the residency match. Hosted by Drs. Michael Gisondi and Michelle Lin, watch the video or listen to the podcast to learn about important changes to the application process and [...]

Trick of the Trade: Hair tourniquet removal using depilatory cream

By |Categories: Pediatrics, Tricks of the Trade|

A hair tourniquet occurs when a strand of hair coils around a patient’s appendage. It can cause damage to the skin, nerves, or affect blood supply. It is more common in infants as their skin appendages are small which allows for hair or thread to trap inside. Because in some cases these pediatric patients can present with inconsolable crying, it is important to perform a thorough physical examination to evaluate for the presence of such a hair tourniquet. We present a simple trick for removing a hair tourniquet using depilatory cream! […]

Resuscitation of a Drowning Victim: A Review

By |Categories: Critical Care/ Resus, Environmental, Trauma|

Drowning cases peak this time of year and represent a leading cause of mortality in children. For example, drowning represents the leading cause of death in boys ages 5-14 years old, and worldwide, there are 500,000 annual deaths from drowning.1 Hypoxic injury and subsequent respiratory failure represent the primary causes of morbidity and mortality. Although providers are typically taught to be aware of possible trauma (e.g. cervical spine fracture) when evaluating a drowning case, less than 0.5% of drownings are traumatic.2 The duration of immersion, volume of aspirated fluid, and water temperature dictate clinical outcomes.1 We review the presentation, pathophysiology, [...]

ACMT Toxicology Visual Pearls: Toxic Mouth Pain

By |Categories: ACMT Visual Pearls, ENT, Tox & Medications|

A middle-aged Asian female presents to the emergency department complaining of 2-3 days of mouth pain. She has chewed betel nut for a number of years. Which of the following is true regarding her presentation and management? Debridement should be avoided. Metronidazole is contraindicated due to the potential of a disulfiram-like reaction. Oral secretagogues should be used due to the anticholinergic effects. The patient is at increased risk of oral cancer. […]

Ultrasound For The Win! – 57F with Chest Pain and Dyspnea #US4TW

By |Categories: Cardiovascular, ECG, Ultrasound, Ultrasound for the Win|

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 57-year-old woman presents with chest pain and dyspnea. […]

SplintER Series: Tibial Plateau Fractures | Leg Day #1

By |Categories: Orthopedic, SplintER|

The SplintER series is back with a new sub-series – Leg Day! We will review lower extremity orthopedic injuries, introduce advanced concepts, and highlight ways to implement these into your next shift. In this post, we summarize the appropriate way to evaluate, diagnose, and manage tibial plateau fractures. This post is peer-reviewed by Dr. Kori Hudson, one of our expert sports medicine colleagues! Please read below for her commentary. […]

Replace dolutegravir (Tivicay) with raltegravir (Isentress) for post-exposure prophylaxis

By |Categories: Infectious Disease, Tox & Medications|

Post-exposure prophylaxis (PEP) of patients who may have been exposed to HIV includes a combination HIV nucleoside analog reverse transcriptase inhibitor emtricitabine/tenofovir (Truvada) plus an integrase inhibitor. The CDC initially recommended the integrase inhibitor dolutegravir (Tivicay). However on May 18, 2018, the CDC placed an alert about the neural tube defect risk with dolutegravir.1 How does this change our ED practice? […]

ALiEM Cards: Maternal Cardiac Arrest

By |Categories: ALiEM Cards, Ob/Gyn|

Maternal cardiac arrest is a low-frequency, high-risk pregnancy complication with 2 lives at stake. Incidence is approximately 1 in 12,000 to 50,000 pregnancies with a greater than 40% mortality rate. Understanding physiologic changes of pregnancy and how to perform a perimortem cesarean section (resuscitative hysterotomy) are critical aspects of caring for maternal cardiac arrest. ALiEM Cards: Maternal Cardiac Arrest, written by Drs. Jeffrey Sakamoto, Collin Michels, Nikita Joshi, and Rebecca Bavolek, reviews the causes, management pearls, and summarizes the perimortem cesarean delivery. […]