PV Card: FAST Ultrasound

By |Categories: ALiEM Cards, Ultrasound|

Keeping in line with the recent ultrasound posts this month, Dr. Mike Stone’s star team is releasing a series of Paucis Verbis cards on the basics of bedside ultrasonography. Here is the first in the series on the Focused Assessment with Sonography in Trauma (FAST) by Drs. Wilma Chan, John Eicken, and Mike Stone. […]

US4TW Case: 28F with Shortness of Breath

By |Categories: Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical), Pulmonary, Ultrasound, Ultrasound for the Win|

Welcome to the inaugural post for an exciting new ultrasound-based case series called “Ultrasound For The Win!” (#US4TW). In this peer-reviewed case series, we will focus on real clinical cases where bedside ultrasound changed the management or aided in the diagnosis. In our first case, we present a 28-year-old female with shortness of breath. […]

Small bowel obstruction: Diagnosis by ultrasonography

By |Categories: Expert Peer Reviewed (Clinical), Gastrointestinal, Pre Publication Critique (Clinical), Ultrasound|

A 64 year old man with an extensive history of abdominal surgeries presents to the emergency department with abdominal pain and vomiting. Because you suspect a bowel obstruction, you bring an ultrasound machine to the bedside prior to the completion of any laboratory testing or other imaging. A curvilinear probe in the abdominal mode setting was used to scan in all four quadrants of the abdomen looking in both the sagittal and transverse planes. […]

Beta Blockers vs Calcium Channel Blockers for Atrial Fibrillation Rate Control: Thinking Beyond the ED

By |Categories: Cardiovascular, Tox & Medications|

Intravenous beta blockers and non-dihydropyridine calcium channel blockers are recommended first-line for atrial fibrillation (AF) with rapid ventricular rate (RVR) [1]. In a previous post, Bryan Hayes (@PharmERToxGuy) provided an overview of the data comparing beta blockers to calcium channel blockers for atrial fibrillation rate control in the ED. Here is part 2 of our two-part AF series.   […]

I am giving prochlorperazine. Should I give diphenhydramine too?

By |Categories: Tox & Medications|

Prochlorperazine is a commonly used medication in EM. In certain patients prochlorperazine does wonders for migraines, and remains a great antiemetic choice for undifferentiated nausea/vomiting when ondansetron is ineffective. However, prochlorperazine has antidopinamergic activity increasing the chances of extrapyramidal symptoms (EPS), such as akathisia, dystonia, parkinsonism, and rarely tardive dyskinesia. A common practice in the ED is to give diphenhydramine with prochlorperazine to attenuate EPS.  Does this really work? What is the evidence? […]

Diagnose on Sight: Swollen Upper Extremity in a Patient with End Stage Renal Disease

By |Categories: Cardiovascular, Diagnose on Sight, Ultrasound|

Case: A 45 year old female with end-stage renal disease presents with 2 days of worsening pain, swelling, and color change of her left upper extremity.  The symptoms began after her left arm arteriovenous (AV) fistula was accessed for hemodialysis. The skin is tense and a bruit is present. What is your diagnosis for this swollen upper extremity? Click on the image for a larger view. […]

AIR Series: HEENT Module 2014

By |Categories: Approved Instructional Resources (AIR series), ENT, Ophthalmology|Tags: |

Welcome to the second 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 US 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 private Google Drive database, which participating residency program directors can access to provide proof of completion. […]

ADJUST-PE Study: ALiEM-Annals of EM Journal Club

By |Categories: Cardiovascular, Journal Club, Pulmonary|Tags: |

We are very excited this month to bring you our fourth ALiEM-Annals of EM Global Journal Club on the use of age-adjusted D-dimer levels to help exclude the diagnosis of pulmonary embolism (PE). We hope you will participate in an online discussion of the four posted questions below from now until August 29th. Respond by commenting below or tweeting (#ALiEMJC). Mark your calendars: On Thursday, August 28th at 16:30 CST (17:30 EST), we will be hosting a 30-minute live Google Hangout with Drs. Jeff Kline and Jonathan Kirschner, the authors of the Annals of Emergency Medicine Journal Club for the ADJUST-PE [...]

Inviting contributors to ALiEM: An open peer-reviewed content submission process

By |Categories: Emergency Medicine, Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical)|

Over the last several years, ALiEM has recruited a team of regular contributors, each with their own individual passions within the entire breadth of Emergency Medicine. ALiEM has provided these individuals with a global platform capable of carrying their message to a target audience of thousands of regular subscribers. Furthermore, the evolution of a rigorous pre-publication Expert Peer Review process has helped ensure that the content is especially polished and scientifically accurate. Today marks a new day. The overwhelming success of the website and editorial process has led us to what we feel is the next step for this academic blog [...]