2018 ACEP Clinical Policy for Patients with Suspected Non-ST Elevation ACS

By |Categories: Cardiovascular, Guideline Review|

A patient presents to your ED with an all too common complaint – chest pain. After a focused history and physical exam, you have an extremely low clinical suspicion for thoracic aortic dissection, pulmonary embolism, pneumonia, pneumothorax, pericarditis/myocarditis, and Boerhaave’s syndrome. When the labs (including a troponin), an ECG, and chest x-ray yield normal results, questions often arise. Can you discharge her with a single troponin if she is low risk? How do you define low risk? And lastly, does she need urgent provocative testing after discharge? […]

IDEA Series Highlights JETem Innovations: A Low Cost Trainer for Neonatal Umbilical Catheterization

By |Categories: IDEA series, Pediatrics|

The Problem Although umbilical catheterization can be a lifesaving technique in the emergent management of a critically ill neonate, it is performed infrequently in the ED.1 Simulation has emerged as a key teaching modality for residents to gain both proficiency and competency with this important procedure.2,3 Commercially available umbilical catheterization models are available, but costly, and often require an expensive investment (over $1,000 for a single trainer).4 This expense may discourage residency programs from acquiring the trainer and offering it to learners. In an effort to minimize this barrier to learning, a team from Kings County Hospital “home built” their own umbilical [...]

Accidental Hypothermia and Cardiac Arrest: Physiology, Protocol Deviations, and ECMO

By |Categories: Critical Care/ Resus, Environmental|

Accidental hypothermia is a life threatening condition that can lead to a challenging resuscitation. The very young, old, and intoxicated patient are at high risk to developing hypothermia, even in temperate climates. The pathophysiologic changes from hypothermia make the standard ACLS approach insufficient to care for the hypothermic patient. This article will discuss the physiology of hypothermia and how you should alter your approach in the hypothermic patient, including early consideration of extracorporeal membrane oxygenation (ECMO). […]

ALiEM AIR Acute Coronary Syndrome Module

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

Welcome to the Acute Coronary Syndrome (ACS) Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the AIR Team is proud to present the highest quality online content related to ACS emergencies. 13 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 11 Honorable Mentions. We recommend programs give 5.5 hours (about 25 minutes per article) of III credit for this module.   […]

Case of a Lethargic Child: Developing a Differential Diagnosis

By |Categories: Pediatrics, Tox & Medications|

A 2-year-old previously healthy boy presents to the emergency department (ED) acting sleepier than usual. Yesterday, he was in his usual state of health, but this morning he didn’t wake up at his usual time of 6 am. When his father went to his room at 7 am, the child was lying in bed. He opened his eyes to look at his father, but did not get out of bed. The mother and father deny any trauma, fever, or seizure activity. […]

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ALiEMU Capsules Module 11: Acute Agitation

By |Categories: ALiEMU, Capsules, Tox & Medications|

We are proud to present Capsules Module 11: Acute Agitation, now published on ALiEMU. We present a summary of the module with key points from a stellar module by PharmDs Jenny Koehl, Kyle DeWitt, Gabrielle Procopio, and Zlatan Coralic. When you’re finished, head over to the Capsules page for even more practical pharmacology for the EM provider. […]

Use of Point-of-care Ultrasound in Tibial Plateau Fractures | Case Presentation

By |Categories: Orthopedic, Radiology, Ultrasound|

A 70-year-old female with no past medical history was hit by a motor vehicle while crossing the street. She experienced no head strike or loss of consciousness, however she was unable to ambulate at the scene, and upon arrival to the ED, complained of left knee pain. The emergency physician noted moderate swelling on exam with intact skin and distal pulses. She was tender to palpation over the proximal tibia. Portable 2-view radiographs were obtained and interpreted as “no acute fracture.” On repeat examination, however, the patient continued to have pain and was now unable to bear weight on the [...]

SAEM is teaming up with us and exclusively sponsoring the AIR Series

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

The Society of Academic Emergency Medicine (SAEM) is now the exclusive, multi-year sponsor of the Approved Instructional Resources (AIR) Series! This series has curated and graded open-access blog posts and podcasts in the field of EM since 2014 to identify and provide high quality, social media-based, educational resources for EM residents. It is one the most used resources for Individualized Interactive Instruction (III) credit, and plus it is free!  We look forward to working more with SAEM, who shares our grand vision for medical education. This aligns perfectly with our recently re-launched ALiEMU "be free to learn" learning management platform, [...]

Reversing Anticoagulation to Administer Systemic Fibrinolytics for Ischemic Stroke: Pump the Brakes

By |Categories: Neurology, Tox & Medications|

Care of acute ischemic stroke patients is a complex and time-sensitive team effort. There is a potentially dangerous trend in the medical literature over the past few years that seems to be increasing as of late: reversing anticoagulation in order to administer systemic thrombolytic therapy. The purpose of this post is to highlight the available literature on this topic, specifically related to the direct acting oral anticoagulants (DOACs), and discuss why we should not support this practice (at least as of today). […]