Lytics for sub-massive PE: Ready for primetime?

By |Categories: Cardiovascular, Pulmonary, Tox & Medications|

There was recently a great study published in the American Journal of Cardiology (2012) by Sharifi et al1, questioning whether we should be considering tPA in patients other than those patients with massive pulmonary embolism (PE)? You know the big “Saddle Embolus” we all fear? Well it turns out this is only about 5% of all PEs. Should we be considering tPA in patients with sub-massive PEs? […]

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Trick of the Trade: Ambient noise and creative cognition

By |Categories: Tricks of the Trade|

For many of us in academia and medical education, we accomplish a tremendous amount of work outside of the workplace. This can be in our home office, on the public transit system, or in the library. Interestingly, creative cognition occurs best with a moderate amount of ambient noise (not too much and not too little), according to a 2012 article from Journal of Consumer Research. […]

Need your input! PV cards becoming an app

By |Categories: ALiEM Cards, Social Media & Tech|Tags: |

It’s all about luck, opportunity, and timing. I will be releasing the blog’s first ever Paucis Verbis (PV) native app this year. After a few years of brainstorming and lots of reader inquiries about an app, we were approached by two different app-building companies in the same week. I’m incredibly humbled to be approached by organizations, who can see the potential of these pocket cards (which started as actual index cards while I was in residency). It is an incredibly exciting time to be in the world of education and social media! I need your help with step 1. [...]

PE in pregnancy: which diagnostic tests do you use?

By |Categories: Cardiovascular, Ob/Gyn, Pulmonary|

Pulmonary embolism (PE) can be a deadly disease and one of the most challenging diagnosis to make in a pregnant patient. Patients may present with signs and symptoms that might also be present in a normal uncomplicated pregnancy. Even in nonpregnant patients, the diagnosis of venous thromboembolism (VTE) such as PE can be quite challenging. […]

Trick of the Trade: External jugular tourniquet

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

Paitents can be a challenge when trying to obtain peripheral IV access. The vein may be collapsed from dehydration or scarred because of IV drug use or repeated cannulation. Before thinking about an ultrasound-guided deep vein IV or a central line, take a look at the external jugular (EJ) vein. There are, however, a few problems that exist when trying to cannulate this site: There is no tourniquet for the neck. To distend the vein, you often need to put the patient in Trendelenburg, which may be uncomfortable or intolerable for some […]

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PV card: Bell’s Palsy Treatment

By |Categories: ALiEM Cards, Neurology|

Bell’s Palsy is an idiopathic unilateral facial nerve paralysis. Since the 2009 Cochrane review1 showing that antivirals added no benefit to corticosteroids in Bell’s Palsy, I stopped prescribing them. The NNT.com site has concluded the same. Looking at the literature a little more, the recommendations are a little murkier. Some groups are still advocating for antivirals for severe cases, because there may be a very small but questionably positive benefit. […]

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Trick of Trade: Umbilical foreign body removal

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

Emergency physicians are constantly challenged with fishing foreign bodies out of various orifices such as ears, as shown here in an earlier Trick of the Trade using a tissue adhesive. What do you do when an overweight person presents with the cotton portion of a Q-tip lodged in his umbilicus? Skin retractors and direct probing were unsuccessful in removing the cotton. […]