Inaugural Global EM Journal Club – hosted by ALiEM and Annals of EM

By |Categories: Journal Club|

CT imaging is a powerful tool in diagnosing pathological medical conditions. Despite this, there is appropriate concern about the “magnitude of imaging-related financial costs and radiation induced malignancies.” In this month’s Annals of Emergency Medicine journal publication, Berdachl et al published about “Emergency Department Computed Tomography Utilization in the United States and Canada.” This article was selected by the journal as the featured piece for a Journal Club discussion. In this inaugural global EM journal club, ALiEM and Annals are collaborating to provide a more dynamic discussion of some of the posed questions. The focus is on teaching concepts around HOW to [...]

NEWS FLASH: ALiEM and Annals EM are hosting a Global Journal Club

By |Categories: Journal Club|

In an unprecedented collaborative effort to accelerate knowledge translation and education, ALiEM is officially partnering with Annals of Emergency Medicine. Together we will be hosting a global Journal Club discussion on ALiEM using the journal club questions posed in the journal’s journal club questions. Here’s how YOU and your colleagues can participate… […]

All Benzodiazepines are Metabolized by the Liver

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

We sometimes hear information stated as fact that may not be entirely accurate. One such example is, “I’m going to use lorazepam because it isn’t metabolized by the liver.” Let’s set the record straight. ALL benzodiazepines are metabolized by the liver.  […]

52 Articles in 52 Weeks: Landmark EM Articles 2013

By |Categories: Cardiovascular, Critical Care/ Resus, EMS, Environmental, Gastrointestinal, Infectious Disease, Neurology, Orthopedic, Pediatrics, Pulmonary, Renal, Trauma, Ultrasound|

To provide a resource for evidence-based Emergency Medical education, this list of must-read landmark articles was created to supplement the Emergency Medicine (EM) internship year of training. There are 52 articles so that one article can be read at leisure each week of the year. I searched national databases and polled faculty at the University of Washington to identify articles that faculty would expect any EM resident to be familiar with or that they felt were practice-changing in EM. Articles were selected for the final list based on the quality of study design, sample size, and relevance for EM residents. [...]

Thyroid Storm: Treatment Strategies

By |Categories: Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Tox & Medications|

The Case You have a 54-year-old female who presents to the emergency department with a chief complaint of “just feeling out of it.” She has felt “off and on” for the past 12 hours and has had an occasional cough with some sputum production along with “the shakes and chills.” She also feels as if her heart was “going at a mile a minute” and because of this, she is very much out of breath. […]

Child Whisperer Series: Just Breathe

By |Categories: Pediatrics, Tricks of the Trade|

Just breathe…. Early in my career as a Child Life Specialist, I was working with a 4 year old girl who needed her port catheter accessed. She was beginning to panic with rapid breathing and moving around. She was clearly on the verge of screaming at any moment. Her panic made everyone in the room feel anxious. I knew I had to do something, so I got on one knee, looked her in the eye and said, “Just breathe.” Without missing a beat, she leaned in closer to me and said, “I am!”… Touché my little friend.   […]

Discussing Annals EM article: Social Media and Physician Learning

By |Categories: Expert Peer Reviewed (Clinical), Medical Education, Social Media & Tech|

I was delighted to see the News and Perspectives piece in this month’s Annals of Emergency Medicine about “Social Media and Physician Learning” (free PDF). I had totally forgotten that Jan Greene, the author, had called to talk with me several months ago. In the piece, she discusses many of the issues with which I struggle: Is peer review good or bad? What is the role of blog and podcast sites in the future of medical education? With the ease of how anyone can be “published” on blogs, how can one decide on the trustworthiness of open educational resources such [...]

5 Tips in Managing Acute Salicylate Poisoning

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

Salicylate is among the top 25 substances that cause the greatest number of overdose fatalities in the United States. 1 Patients can present with a wide variety of complaints including tinnitus, dyspnea, vomiting, confusion, and coma. Significant toxicity occurs when a large amount of salicylate saturates the body’s protein-binding capacity and leaves free salicylate in the serum. 2 The American College of Medical Toxicology (ACMT) recently published a guidance document on management priorities in salicylate toxicity, and it’s definitely worth a read. 3 While not an official clinical guideline, it highlights some important concepts to consider when working up and [...]

Putting an Older Patient Under: Tips for Geriatric Procedural Sedation

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

An 84-year old woman presents to your ED with a traumatic, left-sided posterior hip dislocation. You need to reduce the hip. But how should you sedate her? Procedural sedation is an important component of ED care. It allows us to more comfortably perform otherwise painful procedures such as fracture or dislocation reductions, endoscopies, large laceration repairs, and I&Ds. How safe is procedural sedation in older adults? […]