Trick of the Trade: V-to-Y flap laceration repair for tension wounds

By |Categories: Trauma, Tricks of the Trade|Tags: |

You see a patient with a large V-shaped laceration under tension requiring suture repair. Resist the temptation to simply pull the edges together and close the laceration with simple interrupted or running sutures. Excessive tension on a flap edge during the healing process can compromise its blood supply. This causes ischemia to the healing tissue, which in turn makes that flap edge more likely to dehisce, necrose, and become infected. […]

The Opioid Prescription Epidemic: Annals of EM Resident Perspectives article

By |Categories: Tox & Medications|

Misuse of prescription opioids is one of the defining health problems of our generation.  The dramatic rise of opioid analgesic prescriptions in the US and Canada has been well documented, and opioids represent the most common cause of fatal prescription overdoses. On every shift, in every emergency department in the country, physicians struggle with the concerns of patients presenting with common pain complaints. Seeking to manage their patients’ symptoms in the face of dramatically rising prescription opioid misuse and fatal overdose, emergency physicians are  challenged to distinguish those who are simply seeking pain relief, those who are seeking opioid prescriptions [...]

SimLIFE-EM Challenge: Add to the conversation

By |Categories: Medical Education, Simulation, Tox & Medications|Tags: , |

Debriefings in medical simulation are meant to be the bow on top of the gift that is medical simulation. It is the ultimate delicious dessert, served after a grueling dinner course. All analogies aside, debriefings are meant to drive home the teaching points, to gain a deeper understanding of medical resuscitation as a group, and create mental frameworks of the approach to various patients. But this is often easier described than actually done. We here at ALiEM paired with Dr. Henry Curtis to come up with a creative way of developing debriefing skills and gain deeper understanding of mental frameworks. [...]

Child Whisperer Series: After the Pediatric Code Blue

By |Categories: Pediatrics|

“We need to debrief” said the nurse manager after the medical team walked out of the critical care room after pronouncing a child who died after a traumatic accident. The social worker pointed at me (I am a Child Life Specialist) and looked at her and said “It’s our code blue now. We have to wait. We have a job to do”. Which was her way of saying we still had a lot of work to do with the family. At that point I walked in a room with the social worker and devastated parents, where the patient’s brother waited. He looked at me [...]

Sternoclavicular Joint Dislocations: Diagnosis and Treatment

By |Categories: Orthopedic|

A 16-year-old football player presents to the emergency department directly from a game. He was tackled, falling onto his right shoulder. The patient is complaining of right-sided chest pain. On exam, there is tenderness over the right sternoclavicular joint (SCJ) with a prominent medial clavicle. Range of motion is limited in the right arm. What diagnostic studies need to be performed? What treatment is warranted in the emergency department? […]

AIR Series: Infectious Disease, Hematology, Oncology 2014

By |Categories: Approved Instructional Resources (AIR series), Heme-Oncology, Infectious Disease|Tags: |

Welcome to the first 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 access. […]

New AIR Series: ALiEM Approved Instructional Resources

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

On behalf of the AIR Executive Board, we are excited to introduce the Approved Instructional Resources (AIR) series! The AIR series was conceived to provide a credible method by which an U.S. Emergency Medicine resident can receive academic credit for using Free Open Access Meducation (FOAM) resources. The Executive Board will release a list of high-quality FOAM educational posts and podcasts specially selected by our Executive Board, in parallel with the CORD residency training curriculum. We will have an accompanying quiz for each list and track who completes it. EM residents who complete the quiz can hopefully receive credit for Individualized Interactive Instruction (III) from their EM residency [...]

PV Card: Pediatric Ingestion Dose Thresholds for ED Referral

By |Categories: ALiEM Cards, Expert Peer Reviewed (Clinical), Tox & Medications|

Clinical Toxicology has published guidelines for out-of-hospital management of 16 distinct overdoses and their dose thresholds, above which, pediatric patients should be referred to the Emergency Department for evaluation. Clinical Toxicology is the official journal of the American Academy of Clinical Toxicology (AACT, @AACTinfo), the American Association of Poison Control Centers (AAPCC, @AAPCC), and the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT). There are two caveats to be aware of regarding these guidelines. They were developed between 2005 and 2007. New medications have been approved since that time and there may be more recent data available. As with any poisoning, dose is [...]