Patwari Academy videos: Snake bites!

By |Categories: Patwari Videos|Tags: |

There are about 8,000 snakebites per year in the United States and 10% are fatal (see comments)! If this doesn’t scare you enough to view these videos, watch these videos to see Dr. Rahul’s Patwari’s amazing digital drawing skills. In addition to a brief 4-minute overview on snake bites, Rahul also goes more in depth about crotalids (rattlesnakes) and elapids (coral snakes) specifically. […]

A time-based approach to elderly patients with altered mental status

By |Categories: Expert Peer Reviewed (Clinical), Geriatrics, Neurology|

It’s 7 am on a Monday. Your first patient is an 82 year-old woman who was brought in by EMS from an assisted living facility. All EMS can tell you is that she was not acting herself. You enter her room and introduce yourself. “Hello Mrs. Jones. How are you today?” The woman startles, “Well, you see, I went to put my dog out, and then I was just walking, and couldn’t remember. So it’s all coming full circle, and then I ate a sandwich.” Just then EMS rolls in with another patient, a 75 year-old male coming from home, [...]

PV Card: Intimate partner violence

By |Categories: ALiEM Cards, Trauma|

In the Emergency Department, we too often under-estimate our patients’ likelihood for intimate partner violence (IPV). Unfortunately, there is no perfect screening test to detect this. So one must maintain a high index of suspicion. Once you detect it, what questions should you ask to ensure her/his safety and how do you optimize the resources available to her/him? […]

Alarms from the ventilator: Troubleshooting high peak pressures

By |Categories: Critical Care/ Resus, Expert Peer Reviewed (Clinical)|

Airway management is one of the defining skills of an emergency physician, but our role in the care of intubated patients may continue long after endotracheal tube placement is confirmed. In mechanically ventilated patients, acute elevations in airways pressures can be triggered by both benign and life-threatening causes. When the ventilator alarms, do you know how to tell the difference? What is your approach in troubleshooting the potential problems? […]

Critical Care Series by new ALiEM writer Dr. Todd Seigel

By |Categories: Critical Care/ Resus|

Welcome a new superstar blogger, Dr. Todd Seigel (@ToddSeigelMD), to the ever-growing ALiEM team. I first met Todd at the recent Society of Academic Emergency Medicine meeting. At that time, he was an already established clinician-scholar-educator at Brown University. He had already graduated from residency and was returning to fellowship training to get his board-certification in Critical Care Medicine. I’m thrilled that he is now at my home institution (UCSF) doing this fellowship, where I couldn’t resist recruiting him to join our all-star cast of blog authors. Today is the first of hopefully a long series of critical care/resuscitation topics that are [...]

Quick clinical tip: Elson’s test for the finger

By |Categories: Orthopedic|Tags: |

Injuries to the hand are fraught with multiple, concurrent injuries. Many injuries may have chronic debilitating complications, if not detected early. One such example is a finger laceration with a concurrent extensor tendon injury, causing delayed boutonniere deformity formation and limited function. Review the anatomy of the extensor tendon. View the video on how to perform the Elson’s test to detect a central slip tendon injury. […]

Acute Coronary Syndrome (ACS) in the Elderly

By |Categories: Cardiovascular, Geriatrics|

Acute coronary syndrome (ACS) is the number one cause of mortality in patients older than 65 years old. 1 To complicate this fact further, they also present atypically with weakness, nausea/vomiting, fatigue, and shortness of breath.  It has been shown that older adults who present to the emergency department (ED) with ACS and a chief complaint other than chest pain have worse outcomes: […]

Quick clinical tip: Ulnar collateral ligament injury

By |Categories: Orthopedic|

A common thumb injury is the “gamekeeper’s thumb or “skier’s thumb”, which involves an injury to the ulnar collateral ligament (UCL) of the first MCP joint. It is caused by forced abduction and hyperextension of the thumb, such as from a ski pole. But did you know that there are two branches of the ligament that you should test? […]

Supraventricular Tachycardia (SVT) With Aberrancy Versus Ventricular Tachycardia (VT)

By |Categories: Cardiovascular, ECG, Expert Peer Reviewed (Clinical)|

Differentiating between SVT with aberrancy and VT can be very difficult. It is crucial to be able to make this distinction as therapeutic decisions are anchored to this differentiation. Brugada et al prospectively analyzed 384 patients with VT and 170 patients with SVT with aberrant conduction to see if it was possible to come up with a simple criteria to help differentiate between the two with high sensitivity and specificity. […]