• Posterior tibiofemoral arthroplasty dislocation

SplintER Series: My Knee, Again!

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

A 61-year-old F presents to the ED from the orthopedic clinic with acute right knee pain. She endorses that while a physical exam was being performed, she had sudden onset knee pain. Denies any trauma to the knee, radiation of pain, numbness, tingling, or swelling. The above knee radiographs were obtained (Images courtesy of John Kiel, DO).   […]

ACEP E-QUAL: ACEP Non-STEMI Clinical Policy

By |Categories: Academic, ACEP E-QUAL, Cardiovascular|

In 2018, the American College of Physicians (ACEP) released a Clinical Policy with management recommendations for patients presenting to the emergency department (ED) with concern for non-ST-elevation myocardial infarction (NSTEMI). Dr. Jason Woods hosted an episode of the ACEP E-QUAL Network podcast highlighting key aspects of the new policy. Dr. Woods was joined by lead writer Dr. Christian Tomaszewski from the University of California San Diego, and Dr. Michael Ross, Director of the Chest Pain Center at Emory University. Below are show notes reviewing the recommendations and the process involved in creating the clinical policy.      How is a [...]

ACEP E-QUAL: The Electronic ICU

By |Categories: Academic, Critical Care/ Resus, Podcasts|

  Building on already increasing interest in telehealth, the COVID-19 pandemic accelerated the development and implementation of telemedicine services in a variety of clinical settings. In 2018, Dr. Jason Woods hosted an episode of the ACEP E-QUAL Network podcast highlighting the creation of an electronic intensive care unit (eICU) through Emory Healthcare. In this episode, Dr. Tim Buchman and Critical Care Nurse Cheryl Hiddelson share their innovative approach to delivering critical care services via telehealth. We present highlights from this discussion below.     What is an eICU? The eICU allows for critical care oversight, without having to be on site. [...]

Buprenorphine prescribing: The Get Waivered Initiative makes it easier to get your DEA-X Waiver

By |Categories: Podcasts, Tox & Medications|Tags: |

A major development in curbing the opioid epidemic is the introduction of the medication buprenorphine to address opioid addiction. Being able to prescribe this medication, however, requires a special DEA-X Waiver in the United States. Dr. Alister Martin, the Founder of the Get Waivered initiative, is working to reduce the barriers for clinicians to obtain the training and paperwork necessary to obtain this waiver. Dr. Michelle Lin talks with Dr. Martin on this podcast about the backstory of the Get Waivered program, the lowered barriers to obtaining training, and some sneak peaks on what is new on the launching pad [...]

SAEM Clinical Image Series: Eye Pain After Assault

By |Categories: Academic, Emergency Medicine, Ophthalmology, SAEM Clinical Images, Trauma|

A 33-year-old male presents with intermittent blurry vision and left eye pain for 3 months, and a left-sided orbital headache for 1 day. He reports getting punched in the left side of the head during an altercation a few months ago. The eye pain is worse with ocular movements and is associated with bilateral conjunctival injection and white/green discharge from the left eye. The patient was seen at another emergency department 3 months prior for the same symptoms. He was then found to have left-sided proptosis, visual acuity 20/60 in the left eye, no fluorescein [...]

SAEM Clinical Image Series: Surfing Sting

By |Categories: Academic, Emergency Medicine, SAEM Clinical Images, Tox & Medications|

A 38-year-old male presents 8 days after being stung in the left foot while surfing. He reports the sudden onset of sharp pain while walking in the ocean. He was seen initially in the emergency department. The puncture wound on his left foot was anesthetized, explored, and irrigated. No X-ray was obtained, no foreign body was discovered, and he was discharged home. Two days ago, he noticed worsening heat, itchiness, swelling, and skin changes (red bumps and patches extending from the foot up to the lower calf) in his left foot. His current pain is [...]

Tricks of the Trade in Emergency Medicine book holiday sale

By |Categories: Tricks of the Trade|Tags: |

Well wishes to all of you for this COVID-19 holiday season. As a thank you for your public health efforts and sacrifices during this pandemic, we are discounting our autographed Tricks of the Trade in Emergency Medicine book from $69 to $59 to clear out our remaining few copies [order site]. This sale will end December 31, 2020 or whenever we run out of books in my garage. Get it for yourself, or gift it as coffee-table book for your emergency medicine colleague or trainee. Proceeds go entirely to the ALiEM endeavor to allow us to continue delivering you educational [...]

  • Patellar Subluxation

SplintER Series: I Think My Knee Popped?

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

  13-year-old M presents to the ED with acute left knee pain that occurred about 2 hours prior to arrival while playing football. No direct trauma. Reports two audible “pops” followed by knee instability. Radiograph as pictured (Image 1. Plain film of the left knee. Image courtesy of John Kiel, DO).   Patellar subluxation. This patient likely had a spontaneous dislocation and relocation (the two “pops”). There is a very small avulsion fracture noted along the lateral femoral condyle. PEARL: Patellar subluxations and dislocations are most commonly seen in the pediatric population [1]. PEARL: Patellar subluxation most frequently [...]

SAEM Clinical Images: Man vs Snow Blower

By |Categories: Academic, Emergency Medicine, Orthopedic, SAEM Clinical Images, Trauma|

A 28-year-old man presents to the emergency department after a snow blower accident while at work. The patient was performing maintenance and he placed his hand into a clogged snow blower while the machine was still on. His hand subsequently got jammed in the snow blower, catching his second and third digits. The patient has an obvious amputation of the right third digit with the stump still connected to the hand via the flexor tendon, which is attached to the distal phalanx. He has pain in the right hand and lack of sensation to the [...]

ALiEM AIR Series | Immunology 2020 Module

By |Categories: Approved Instructional Resources (AIR series), Infectious Disease|Tags: |

Welcome to the AIR Immunology 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 immunology in the Emergency Department. 5 blog posts within the past 12 months (as of September 2020) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 2 AIR and 3 Honorable Mentions. We recommend programs give 3 hours (about 30 minutes per article) of III credit for this module. AIR Stamp [...]