Climate Change and Emergency Medicine: A Specialty on the Frontline
Emergency medicine (EM) is on the frontlines of climate change, which the Lancet Commission declared “the biggest global health threat of the 21st century” with “potentially catastrophic risk to human health.”1,2 Climate change is having broad and profound negative impacts on the health of our patients, especially for the vulnerable populations. It is also affecting our healthcare systems and mandating the creation of climate-resilient emergency departments (ED) with robust disaster preparedness. EM needs to engage climate change advocacy efforts for 2 key reasons. It has a profound impact on our specialty, and it is built into the moral fiber of [+]
Ketamine for Severe Ethanol Withdrawal: A New Hope?
Ethanol withdrawal is a complex disease state. Two of the main players are GABA (an inhibitory neurotransmitter) and glutamate (an excitatory transmitter that can act on NMDA receptors). Simplistically, chronic ethanol use leads to a down-regulation of GABA receptors and an up-regulation in glutaminergic receptors, such as NMDA. When ethanol is abruptly discontinued, we are left with a largely excitatory state with less ability for GABA-mediated inhibition and more capacity for NMDA/glutamate-mediated excitation. While much of the treatment of severe ethanol withdrawal is focused on GABA, there are agents, such as phenobarbital and propofol, that can suppress the glutaminergic response. [+]
ALiEM AIR Series: Ear, Nose, and Throat (ENT) Module
Welcome to the Ear, Nose, and Throat (ENT) Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to ENT emergencies. 8 blog posts within the past 12 months (as of December 2017) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 1 AIR and 7 Honorable Mentions. We recommend programs give 3 hours (about 20 minutes per article) of III credit for this module. [+]
ACMT Toxicology Visual Pearls: Spider Bite
A patient presents to the ED for management of a spider bite. Which of the following statements is correct regarding a bite from the spider pictured? Laboratory studies can be helpful in management and predicting outcome. Antibiotics are recommended. The venom is cytotoxic and can cause red blood cell hemolysis. The venom is more potent on a volume-per-volume basis than the venom of a pit viper. [+]
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Podcast Follow-up: Interview with Dr. Debbie Yi Madhok, Co-Author of “Update on the ED Management of Intracranial Hemorrhage”
Intracranial hemorrhage (ICH) is associated with significant disability and mortality. Although evidence-based guidelines exist, many hospitals have their own institutional practice patterns, which can make it difficult to care for these patients in the ED. Dr. Debbie Yi Madhok, an emergency physician and neurointensivist, sat down with Dr. Derek Monette, the ALiEM Deputy Editor in Chief, to discuss updates in the management of ICH. This interview follows up her original popular 2017 ALiEM post on dilemmas in ICH management, and takes a deeper dive into the nuances of seizure prophylaxis, blood pressure control, and platelet transfusions. We present the podcast and [+]
Herbal Induced Delirium: The Toxicologist Mindset
The Toxicologist Mindset series features real-life cases from the San Francisco Division of the California Poison Control System. Case: A previously healthy 49-year-old woman presented to the emergency department (ED) with acute onset of confusion. Family members noticed her to have unsteady gait and she complained of blurry vision and difficulty urinating. She denied the use of any drugs or alcohol and took no medications. In the ED, her vital signs were: T 98.7, BP 95/59, P 130, RR 16, and O2 sat 100% on room air. Her pupils were 7 mm and reactive and her skin was dry. Bowel [+]
10 Tips to Improve Patient Satisfaction in the Emergency Department
Exceptional communication is essential when providing care to patients in the ED. This is especially true given that we don’t have a preexisting relationship with our patients. They have never seen us before, have little or no information about us, and didn’t choose us. They are typically anxious, uncomfortable, and would probably rather be somewhere else. Exceptional communication allows patients to gain trust in us, in our skills, and in our recommendations. Strong communication skills not only allow physician and non-physician staff to gather relevant information and share important findings, but also help improve healthcare outcomes, reduce misunderstandings, and minimize [+]
PEM Pearls: Red Flags for Child Abuse – Case 1
Child abuse is a common cause of pediatric morbidity and mortality. In 2015, over 650,000 children were found to be victims of maltreatment and over 1,500 child deaths occurred due to child abuse or neglect in the United States.1 Children under 1 year of age are at the highest risk of abuse with potential for lifelong sequelae. Emergency department providers are in a unique position to recognize child abuse and take appropriate steps to reduce further injury to children. An understanding of the motor development of young children can aid physicians in the identification of clinical red flags in the [+]
A Can’t Miss ED Diagnosis: Euglycemic DKA
A middle-aged man with a history of diabetes and hypertension presents with nausea, vomiting, and shortness of breath. His laboratory testing is remarkable for a leukocytosis, ketonemia, and an anion gap acidosis (pH of 7.13). The EM resident caring for this patient is surprised to find that the blood glucose is 121 mg/dL. Which home medication is likely responsible for this presentation? Metformin Glipizide Liraglutide Canagliflozin Canagliflozin: An SGLT2 Inhibitor The patient's presentation is consistent with diabetic ketoacidosis (DKA) in the absence of hyperglycemia. This entity is known at euglycemic DKA and it is increasingly recognized for an association with [+]
Resilience in EM Despite Litigation: An Interview with Dr. Gita Pensa
You have just signed out from one of the best shifts in your career. You feel like you were born to do this! You’re a great EM doctor! Then, you spot him, a man in a dark suit making eye contact as you walk through the lobby towards the exit. He stops and asks, “Are you Dr. About-to-get Sued?” Being named in a malpractice lawsuit is a potentially devastating, frequently unmentioned, and yet rather common event in EM. Providers may find themselves feeling isolated and ashamed, questioning their career choice regardless of the trial outcome. Members of the ALiEM Wellness [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Latest posts by Shuhan He, MD (see all)
- The Discharge Severity Index: Early Research on ED Readmission Risk Assessment - August 14, 2025
- Suboxone and the Emergency Physician: Get Waivered Training - August 12, 2022
- A Tale of Two Epidemics: COVID-19 and the Opioid Crisis - April 23, 2020