ACMT Toxicology Visual Pearls: Spider Bite

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

A patient presents to the ED for management of a spider bite. Which of the following statements is correct regarding a bite from the spider pictured? Laboratory studies can be helpful in management and predicting outcome. Antibiotics are recommended. The venom is cytotoxic and can cause red blood cell hemolysis. The venom is more potent on a volume-per-volume basis than the venom of a pit viper. […]

Podcast Follow-up: Interview with Dr. Debbie Yi Madhok, Co-Author of “Update on the ED Management of Intracranial Hemorrhage”

By |Categories: Neurology, Tox & Medications, Trauma|

Intracranial hemorrhage (ICH) is associated with significant disability and mortality. Although evidence-based guidelines exist, many hospitals have their own institutional practice patterns, which can make it difficult to care for these patients in the ED. Dr. Debbie Yi Madhok, an emergency physician and neurointensivist, sat down with Dr. Derek Monette, the ALiEM Deputy Editor in Chief, to discuss updates in the management of ICH. This interview follows up her original popular 2017 ALiEM post on dilemmas in ICH management, and takes a deeper dive into the nuances of seizure prophylaxis, blood pressure control, and platelet transfusions. We present the podcast and [...]

Herbal Induced Delirium: The Toxicologist Mindset

By |Categories: Neurology, Tox & Medications|

The Toxicologist Mindset series features real-life cases from the San Francisco Division of the California Poison Control System. Case: A previously healthy 49-year-old woman presented to the emergency department (ED) with acute onset of confusion. Family members noticed her to have unsteady gait and she complained of blurry vision and difficulty urinating. She denied the use of any drugs or alcohol and took no medications. In the ED, her vital signs were: T 98.7, BP 95/59, P 130, RR 16, and O2 sat 100% on room air. Her pupils were 7 mm and reactive and her skin was dry. Bowel [...]

10 Tips to Improve Patient Satisfaction in the Emergency Department

By |Categories: Administrative|

Exceptional communication is essential when providing care to patients in the ED. This is especially true given that we don’t have a preexisting relationship with our patients. They have never seen us before, have little or no information about us, and didn’t choose us. They are typically anxious, uncomfortable, and would probably rather be somewhere else. Exceptional communication allows patients to gain trust in us, in our skills, and in our recommendations. Strong communication skills not only allow physician and non-physician staff to gather relevant information and share important findings, but also help improve healthcare outcomes, reduce misunderstandings, and minimize [...]

PEM Pearls: Red Flags for Child Abuse – Case 1

By |Categories: PEM Pearls|

Child abuse is a common cause of pediatric morbidity and mortality. In 2015, over 650,000 children were found to be victims of maltreatment and over 1,500 child deaths occurred due to child abuse or neglect in the United States.1 Children under 1 year of age are at the highest risk of abuse with potential for lifelong sequelae. Emergency department providers are in a unique position to recognize child abuse and take appropriate steps to reduce further injury to children. An understanding of the motor development of young children can aid physicians in the identification of clinical red flags in the [...]

ALiEMCards: Preeclampsia

By |Categories: ALiEM Cards, Ob/Gyn|

Preeclampsia is on a spectrum of pregnancy related illness that includes eclampsia and HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets – debate exists about if this is a separate entity altogether). It carries a high mortality for both mom and baby, and can lead to a number of complications including pulmonary edema, hepatic rupture, placental abruption, and seizures (eclampsia). Created by Dr. Sam Ashoo, ALiEM Cards: Preeclampsia gives you a rapid review of its presentation, criteria, and management. […]

A Can’t Miss ED Diagnosis: Euglycemic DKA

By |Categories: Endocrine-Metabolic, Tox & Medications|

A middle-aged man with a history of diabetes and hypertension presents with nausea, vomiting, and shortness of breath. His laboratory testing is remarkable for a leukocytosis, ketonemia, and an anion gap acidosis (pH of 7.13). The EM resident caring for this patient is surprised to find that the blood glucose is 121 mg/dL. Which home medication is likely responsible for this presentation? Metformin Glipizide Liraglutide Canagliflozin […]

Resilience in EM Despite Litigation: An Interview with Dr. Gita Pensa

By |Categories: Medicolegal, Wellness, Wellness Think Tank|

You have just signed out from one of the best shifts in your career. You feel like you were born to do this! You’re a great EM doctor! Then, you spot him, a man in a dark suit making eye contact as you walk through the lobby towards the exit. He stops and asks, “Are you Dr. About-to-get Sued?” Being named in a malpractice lawsuit is a potentially devastating, frequently unmentioned, and yet rather common event in EM. Providers may find themselves feeling isolated and ashamed, questioning their career choice regardless of the trial outcome. Members of the ALiEM Wellness [...]

MEdIC: Case of the Night Shift Stimulants – Expert Review and Curated Community Commentary

By |Categories: MEdIC series, Tox & Medications|

Our fifth case of season 5, The Case of the Night Shift Stimulants, presented the scenario of a junior emergency medicine (EM) resident who witnesses her attending physician taking stimulants in order to function during his night shift. The MEdIC team (Drs. Tamara McColl, Teresa Chan, Sarah Luckett-Gatopoulos, Eve Purdy, John Eicken, Alkarim Velji, and Brent Thoma), hosted an online discussion around the case over the last 2 weeks with insights from the ALiEM community. We are proud to present to you the curated commentary and our expert opinions. Thank-you to all participants for contributing to the very rich discussions surrounding [...]

SplintER Series: Complications & Discharge Care Plans | Splint Principles 103

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

The SplintER Series is back with its third installment! In this series, we review splinting fundamentals, introduce advanced concepts, and highlight ways to implement these into your next shift. In SplintER 102, we reviewed the materials used in splinting and a general approach to applying a splint. Today’s post puts the spotlight on some of the potential complications of splinting, discharge care plans, and pharmacological adjuncts to aid in recovery. […]