PEM POCUS Series: Pediatric Lung Ultrasound

By |Categories: Expert Peer Reviewed (Clinical), Pediatrics, PEM POCUS, Radiology, Ultrasound|

Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric lung ultrasound. 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 Lung Ultrasound Quiz Module Goals List indications for performing a pediatric lung point-of-care ultrasound (POCUS). Describe the technique for performing lung POCUS. Recognize anatomical landmarks and artifacts related to lung POCUS. Interpret signs of a consolidation, interstitial fluid, effusion, and pneumothorax on POCUS. Describe the limitations of lung POCUS. Child with [+]

SAEM Clinical Images Series: Back Yard Football Injury

By |Categories: Orthopedic, SAEM Clinical Images, Sports Medicine|

A 10-year-old male with no past medical history presents to the Emergency Department (ED) by EMS for evaluation of an injury sustained while playing tackle football. The patient was forcibly hit by another child against a tree. He complains of sharp right shoulder and chest pain that worsens with movement of his right upper extremity and he arrives wearing a sling to immobilize the arm.   Vitals: BP 123/86; HR 121; RR 25; T 37°C General: Alert and oriented, in moderate distress Cardiovascular: RRR without murmurs, rubs, or gallops, peripheral pulses 2+ [+]

  • pressure bag IV fluids

Trick of Trade: Alternative to a Pressure Bag for IV Fluids

By |Categories: Cardiovascular, Critical Care/ Resus, Tricks of the Trade|

You have a severely dehydrated patient with a peripheral IV line, requiring urgent fluid resuscitation. However, the crystalloid fluids are not flowing freely. Multiple attempts were made to place this line with the latest having a flash of blood return and a smoothly flowing saline flush. You can not seem to find your pressure infusion cuff to squeeze the IV bag and accelerate fluid administration. Trick of the Trade: Manually provide positive pressure fluids using a 3-way stopcock Attach a 3-way stopcock between the angiocatheter and IV tubing. In the unused port, attach a 10 or 20 cc syringe. [+]

ALiEM AIR Series | Infectious Disease 2023 Module

By |Categories: ALiEMU, Approved Instructional Resources (AIR series), Expert Peer Reviewed (Clinical), Infectious Disease|

Welcome to the AIR Infectious Disease Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Digital Impact Factor [1], the ALiEM AIR Team is proud to present the highest quality online content related to related to infectious diseases in the Emergency Department. 6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. More specifically, we identified 1 AIR and 5 Honorable Mentions. We recommend programs give 3 hours of III credit for this module. AIR Stamp of Approval and [+]

  • lily of valley flower acmt

ACMT Toxicology Visual Pearl: The Heart Won’t Go On and On

By |Categories: ACMT Visual Pearls, Cardiovascular, Environmental, Expert Peer Reviewed (Clinical), Tox & Medications|

Which cardiotoxic plant is shown? Lily of the valley Moonflower Morning glory Water hemlock White snakeroot [+]

Sheila Goertemoeller, PharmD, DABAT, ICPS

Sheila Goertemoeller, PharmD, DABAT, ICPS

Clinical Toxicologist and Educator
Drug and Poison Information Center
Cincinnati Children's Hospital Medical Center
Sheila Goertemoeller, PharmD, DABAT, ICPS

Latest posts by Sheila Goertemoeller, PharmD, DABAT, ICPS [+]

  • cone snail shell botulinum

ACMT Toxicology Visual Pearl: Marcel the Shell with Toxins

By |Categories: ACMT Visual Pearls, Dermatology, Environmental, Expert Peer Reviewed (Clinical), Tox & Medications|

The venom from this pictured snail shares a primary mechanism of action with what other deadly toxin? Alpha-latrotoxin Botulinum toxin Bufotoxin Tetanus toxin Sarin [+]

Aaron Frolichstein, MD

Aaron Frolichstein, MD

Resident
Department of Emergency Medicine
Carolinas Medical Center
Aaron Frolichstein, MD

  • black eschar anthrax

ACMT Toxicology Visual Pearl: The Black Eschar

By |Categories: ACMT Visual Pearls, Dermatology, Expert Peer Reviewed (Clinical), Tox & Medications|

Which of the following is the most likely explanation for this skin lesion in a worker handling sheep hides? Bacillus anthracis Group A streptococcus Pseudomonas aeruginosa Staphylococcus aureus (Photo credit: CDC/ James H. Steele, Public domain via Wikimedia Commons) [+]

Alex Blackwell, MD

Alex Blackwell, MD

Resident
Department of Emergency Medicine
Carolinas Medical Center
Alex Blackwell, [+]</p></body></html>

Phenobarbital as First-Line Medication for Alcohol Withdrawal: Have You Switched From Benzodiazepines Yet?

By |Categories: Neurology, Tox & Medications|

Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? If not, you probably should be. Another old drug for a new indication, right? Well not exactly. Phenobarbital is indeed an older and relatively cheap drug (less than $20 per loading dose) that has gained some press recently for the treatment of acute alcohol withdrawal [1-3]. Why should you consider using phenobarbital as monotherapy rather than benzodiazepines? Phenobarbital used to be one of the standard treatments for ethanol (EtOH) withdrawal prior to the introduction of benzodiazepines. However, there [+]

Trick of Trade: Dual Foley catheter to control massive epistaxis

By |Categories: Genitourinary, Pediatrics, Tricks of the Trade|

Massive epistaxis is considered a medical emergency that requires immediate attention. Symptoms of massive epistaxis include sudden and heavy bleeding from the nose, difficulty breathing, dizziness, and a rapid heartbeat. If left untreated, it can lead to significant blood loss, shock, airway obstruction, and even death. We report a case of a 50-year-old man with end stage renal disease with massive nasal bleeding from the left nostril, shortness of breath, and confusion. Initial Management After a rapid assessment, we inserted an anterior nasal pack, soaked in epinephrine, TXA, and an antibiotic-based lubricant. However, the bleeding continued from his nares [+]

Trick of Trade: Removal of Entrapped Metal Zipper

By |Categories: Genitourinary, Pediatrics, Tricks of the Trade|

A young boy is brought to the pediatric emergency screaming at the top of his lungs by his parents. His penile skin is trapped in the zipper of his jeans. On a busy shift, you want a simple way to handle zipper injuries that minimizes pain, doesn't require resource-intensive procedural sedation, and is quick. Background The 4 most common types of zippers are nylon coil zip, plastic mold zip, metal zip, and invisible zip. Most of the techniques describing solutions on zipper entrapment in the medical literature are derived from case reports and case series. All revolve around understanding [+]

Shuhan He, MD
ALiEM Senior Systems Engineer;
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Shuhan He, MD