Carbon Monoxide Poisoning – It’s That Time of Year Again

By |Categories: Tox & Medications|

Carbon monoxide (CO) poisoning may be the most common cause of fatal poisonings worldwide. 1 The majority of poisonings occur in the Fall and Winter. It is that time of year when heaters that have lain dormant all summer are flicked on, sometimes in enclosed areas, introducing CO fumes into homes. The pathophysiology is complex, and not fully understood, but all ED physicians should be aware of the signs and symptoms of CO toxicity, and know how to treat it. […]

Top 10 Reasons NOT to Order a CT Pan Scan in a Stable Blunt Trauma Patient

By |Categories: Radiology, Trauma|

The pendulum has swung one way with CT for trauma, but has it gone too far? Liberal use of CT raises concerns over resource utilization, cost, and the consequences of radiation exposure [1,2]. No-one can seem to agree, including trauma surgeons, on guidelines for a more selective use of imaging studies [3-6]. “CT pan scan” is the term, source unclear, which describes the whole body CT (WBCT) imaging strategy used in blunt trauma management. It consists of the following CT studies: […]

Trick of the Trade: Insect removal from the ear

By |Categories: ENT, Tricks of the Trade|

Insect removal from the ear is a foreign body removal procedure with unique considerations. First, insects are friable. Have you ever squashed a house centipede? It’s like their 700 legs are spring-loaded to fall off instantly when touched. This characteristic makes mechanical removal by alligator forceps or cerumen loops less reliable. Second, they are alive which means they can move during your attempted extraction procedure. […]

AIR Series: Endocrinology Module 2014

By |Categories: Approved Instructional Resources (AIR series), Endocrine-Metabolic|

Welcome to the third ALiEM Approved Instructional Resources (AIR) Module! In an effort to reward our readers for the reading and learning they are already doing online, we have created an Individual Interactive Instruction (III) opportunity utilizing FOAM resources for U.S. Emergency Medicine residents. For each module, the board curates and scores a list of blogs and podcasts. A quiz is available to complete after each module to obtain residency conference credit. Once completed, your name and institution will be logged into our privatedatabase, which participating residency program directors can access to provide proof of completion. […]

Bleeding and Hemophilia in the Pediatric ED

By |Categories: Expert Peer Reviewed (Clinical), Heme-Oncology, Pediatrics|

Bleeding as a chief complaint in the pediatric emergency department is something that many healthcare providers will come across. Some of these children may have inherited bleeding disorders that we must be aware of in order to provide the best care possible. Below is a basic review of hemophilia and what we should know and do in the emergency department. […]

High risk back pain: Spinal Epidural Abscess

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

Spinal epidural abscess (SEA) is a rare but potentially catastrophic cause of back pain. Classically these patients are described as having back pain, fever, and clear neurologic deficits. In reality, patients often present with less obvious symptoms which often leads to a delay in diagnosis. Missed cases of SEA are a source of significant risk to both the patient and the provider. To improve outcomes and minimize risk, providers must identify and promptly evaluate patients who are at increased risk of developing a SEA. […]

Diagnose on Sight: “I feel like I am having a heart attack”

By |Categories: Diagnose on Sight, Pulmonary, Radiology|

Case: A 18-year-old male with no medical history presents to the emergency department (ED) complaining of “feeling like I am having a heart attack” which started suddenly 1 hour ago. The patient ate from a food truck the night before and developed several episodes of forceful vomiting prior to arrival in the ED. What finding in this supine chest radiograph aids in the diagnosis? Click on image for a larger view. […]

Vomiting in Kids After Head Trauma: To CT or Not to CT?

By |Categories: Pediatrics, Trauma|

A 6-year-old male is brought to the emergency department (ED) after falling from the monkey bars at a local playground. Physical examination reveals no scalp hematoma, and the child appears alert and well oriented. You decide to observe him over the next 30 minutes hours to determine if he develops any disconcerting symptoms. After 15 minutes of observation within the ED the patient has an episode of vomiting witnessed by the nurses. The patient’s mother wants to know if this means he has failed his observation period and needs to receive a head CT. Your answer? […]

Antidiabetic Medications: Hypoglycemic Potential in Overdose

By |Categories: Endocrine-Metabolic, Tox & Medications|

With several new diabetes medications available, it is important to know which ones are likely to cause hypoglycemia after overdose. Based on mechanism of action and reported cases, the likelihood of hypoglycemia after overdose is listed below by drug class. 1 Keep in mind that other drugs can interact with antidiabetic medications resulting in hypoglycemia. The following table applies only to single agent ingestion/administration. […]

  • Ultrasound

PV Card: Focused Abdominal Aorta Ultrasound

By |Categories: ALiEM Cards, Cardiovascular|

In this next ultrasound installment in the PV Card series, Drs. Victoria Koskenoja, Heidi Kimberly, and Mike Stone succinctly summarize the focused abdominal aorta ultrasound to assess for an abdominal aortic aneurysm (AAA). These can serve as key reference cards when you do your next AAA scan. Don’t miss the last card with tips on optimizing the view and common pitfalls. […]