PEM Pearls: Metered-Dose Inhaler versus Nebulizer
An 8-year-old is brought in by her parents with shortness of breath and wheezing. She’s been receiving her “rescue inhaler” at home and continues to have symptoms. You examine her and find that she has normal oxygen saturation, mild tachypnea and retractions, and diffuse wheezes. You think that she’s experiencing an acute asthma exacerbation. Given the current pandemic, and a recent report that administering nebulizer treatments to COVID-19 positive patients was correlated with transmission of COVID-19 to healthcare workers [1], what is the best way to treat the patient? [+]
ACMT Toxicology Visual Pearls: I’ll Huff and I’ll Puff…
The abuse of which common office supply substance can result in syncope and the EKG findings shown? Dust Off (difluoroethane) Elmer’s glue (polyvinyl acetate) Hand sanitizer (ethyl alcohol) Rubber cement (heptane, isopropyl alcohol) [+]
Kathryn T. Kopec, DO
Carolinas Medical [+]
Silence is not an option: Addressing structural racism in medical education
The year 2020 has been a year of upheaval. The COVID pandemic revealed disparities in healthcare and its effects on marginalized groups such as the Black community. The pervasive effects of structural racism affect all of us, including in medical education. We cannot and must not remain silent. As we honor Juneteenth, #BlackLivesMatter, and #WhiteCoatsforBlackLives, let us reflect on ways we can address racial injustice in our direct environment. [+]
Hydroxychloroquine Toxicity
As the COVID-19 pandemic continues to unravel, the role of hydroxychloroquine (HCQ) in the treatment of patients with this disease has been a major focus of discussion on the news and social media. Despite the lack of good data supporting its use in the clinical setting, there have been numerous reports of individual consumption of HCQ resulting in accidental overdose and even death. It is therefore important to recognize and manage patients who may present with HCQ toxicity. [+]
Trick of the Trade: Windex for Ring Removal
A 41-year-old male presents with left-hand pain after an altercation. The patient’s hand is noted to be swollen and tender, particularly over the 4th-5th metacarpals, with mild swelling extending to the 4th-5th digits. The patient also notes that he slightly deformed his wedding ring during the fight and he has since been unable to remove it. It’s a busy overnight and the patient has been in the waiting room for an hour. While waiting nursing staff had the patient ice his hand while elevated and attempted to remove the ring with a water-based lubricant. All attempts to remove the ring [+]
Trick of the Trade: Angiocatheter for manual aspiration of priapism
A 25-year-old man presents with 6 hours of penile pain and swelling after recreational penile injection of Trimix (alprostadil, papaverine, and phentolamine). He denies any history of sickle cell disease or penile trauma. On exam, he is in moderate discomfort and has a tumescent penis with a soft glans. You suspect the patient is suffering from ischemic, low-flow priapism. Manual compression and ice application have been attempted with no significant improvement in the patient’s clinical status. [+]
ACMT Toxicology Visual Pearls: A Foraging Experience to Die For
What life-threatening symptoms can result from the ingestion of this plant? Delayed onset bone marrow suppression Hepatic failure Mucosal swelling of the anterior airway Paralysis and respiratory failure [+]
Robert Goodnough, MD
Department of Emergency Medicine, Baylor College of Medicine
Latest [+]
Trick of the Trade: Sodium Bicarbonate for Acute Symptomatic Hyponatremia
A 25-year-old woman is brought into the emergency department by friends due to “acting weird.” She was at a rave and is reported to have consumed alcohol, marijuana, and ecstasy. On exam, she is afebrile, tachycardic, normotensive, and breathing comfortably on room air. She is lethargic, mumbling incomprehensibly, and does not follow commands. Her glucose is 115 mg/dL, her pregnancy test is negative, her EKG reveals sinus tachycardia, her ethanol level is 30 mg/dL, and a stat CT head is negative. Her chemistry panel reveals a sodium level of 114 mEq/L. You order a 100 mL 3% sodium chloride bolus, [+]
Social Distancing Simulation: Tips for Leading a Virtual Session With Student Learners
We’ve all had to get a bit creative over the past few weeks. COVID-19 has ushered in an era of not only pushing healthcare workers and hospitals into uncharted territory, but also challenging the structure and delivery of medical education. Simulation education is one of many teaching modalities that is affected by this change given its case-based, in-person structure with a team of learners. These characteristics unfortunately violate the 6-foot rule of social distancing. While traditional simulation is not typically conceptualized as a virtual modality, many of its principals can be successfully adapted for remote learning. [+]
PEM Pearls: Chest Radiographs for Shortness of Breath
Figure 1: Photo by Tim Bish on Unsplash Paramedics bring in a 5-month-old boy in respiratory distress. He’s crying furiously and has normal tone and color. Thick, copious secretions are coming from his nose. He is tachypneic with diffuse wheezes, crackles, retractions, and nasal flaring. His respiratory rate is 70 and his oxygen saturation is 88% on room air. Would you order a chest radiograph (CXR) for this child? CXRs are routinely obtained in adults with respiratory symptoms. Children, however, are more sensitive to radiation and can have multiple respiratory infections every year. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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