My EpiPen expired! Can I still use it?

By |Categories: Tox & Medications|

The above question is common from patients with a history of an allergic reaction seen for a repeat emergency department visit. The manufacturers of EpiPen caution not to use the pen beyond the expiration date, and if the drug solution becomes discolored (oxidation). But EpiPens are expensive! Is there harm in using the pen beyond the expiration date? What should we tell our patients?1 […]

PEM Pearls: Treatment of Pediatric Diabetic Ketoacidosis and the Two-Bag Method

By |Categories: Endocrine-Metabolic, Pediatrics, PEM Pearls|

Insulin does MANY things in the body, but the role we care about in the Emergency Department is glucose regulation. Insulin allows cells to take up glucose from the blood stream, inhibits liver glucose production, increases glycogen storage, and increases lipid production. When insulin is not present, such as in patients with Type 1 diabetes mellitus (DM), all of the opposite effects occur. […]

PECARN Pediatric Head Trauma: Official Visual Decision Aid for Clinicians

By |Categories: Pediatrics, Trauma|Tags: |

The Pediatric Emergency Care Applied Research Network (PECARN) collaborative has teamed up with the ALiEM and CanadiEM teams to introduce the official PECARN visual decision rule aid for pediatric blunt head trauma! This has been a 6 month collaboration focused on bringing evidence-based research to the bedside in pediatric emergency medicine (EM). […]

AIR Series: Toxicology Module (2017)

By |Categories: Approved Instructional Resources (AIR series), Tox & Medications|

Welcome to the Toxicology 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 toxicology content. Below we have listed our selection of the 6 highest quality blog posts within the past 12 months (as of January 2017) related to Toxicologic emergencies, curated and approved for residency training by the AIR Series Board. More specifically in this module, we identified 0 AIRs and 6 Honorable Mentions. We recommend programs give 2 hours (about 20 minutes per article) of III credit for this module. As of June 2017, the AIR [...]

Envenomations: Initial Management of Common U.S. Snakebites

By |Categories: Environmental|

Nothing says “emergency” like a bite from a venomous reptile. If you work in an area populated by snakes, which covers most of the United States and the world, then chances are good that you will see a patient with a snake bite in the Emergency Department (ED). The severity of the symptoms and the treatment vary greatly with different snakes. In this post, we will outline the ED approach to and management of common U.S. snake envenomation. […]

EM Pharmacotherapy Guidelines and Position Statements: Resource for ED Rotations

By |Categories: Tox & Medications|

Several years ago I created a resource for my ED rotation that I share with pharmacy students, pharmacy residents, and EM physician residents. It contains most of the guidelines and position statements on EM drug therapy that I utilize most often and is updated as new iterations are published. We’d like to share this tool with you to be used/modified to meet your rotation needs. Last updated: February 22, 2018 […]

Little Patients, Big Medicine Podcast: Lactate in Pediatric Sepsis

By |Categories: Infectious Disease, Pediatrics|Tags: |

The first recording from Little Patients, Big Medicine: the Pediatric Emergency Medicine (PEM) Podcast. This is an exciting interview with Dr. Halden Scott, a PEM physician at Children’s Hospital Colorado, about the use of lactate measurement in pediatric sepsis. Dr. Scott is one of the premier pediatric sepsis researchers, with a specific focus on the use of lactate measurement in the ED. We talk about the Sepsis-3 definitions and whether pediatrics will eventually follow them, Dr. Scott’s previous work on lactate use in the pediatric ED, and her new article published in March of 2017 on the association between elevated [...]

Trick: Linear Ultrasound Transducers in Intrauterine Pregnancy Evaluation

By |Categories: Ob/Gyn, Tricks of the Trade, Ultrasound|

The volume of women presenting to the emergency department (ED) with newly diagnosed first-trimester pregnancies and suspected ectopic pregnancies sometimes seems like an infinitely growing number. As ED physicians, proper identification of an intrauterine pregnancy (IUP) in these patients is of paramount importance and the initial imaging test of choice for many has become bedside point-of-care ultrasound (POCUS). […]

Beyond the Abstract | Shared Decision-Making in the ED: 3 Factors That Matter

By |Categories: Beyond the Abstract|

Shared decision-making seems to be more popular than Snapchat these days. Everyone in emergency medicine is talking about it… but who is actually doing it properly? In our recent concepts piece published in Annals of Emergency Medicine, we describe 3 key factors that must be present for shared decision-making (SDM) to be appropriate in the emergency department (ED). […]

Traumatic Bleeding in Anticoagulated Patients: 5 Other Sources Beyond the Brain

By |Categories: Heme-Oncology, Trauma|

When a patient is started on anticoagulant therapy, the purpose is to prevent clot formation or propagation. Anticoagulants can improve morbidity and mortality by maintaining cardiac stent patency, reducing the propagation of pulmonary emboli, or preventing formation of intra-cardiac thrombi.1,2 Unfortunately even after minor trauma, these medications can cause major problems. When a patient on clopidogrel is in a motor vehicle collision (MVC) or an elderly patient on warfarin falls out of their bed, the once life-improving therapy becomes potentially life-threatening. It is important for emergency care providers to maintain a high index of suspicion for life-threatening bleeds in all patients on [...]