• lily of valley flower acmt

ACMT Toxicology Visual Pearl: The Heart Won’t Go On and On

By |Categories: ACMT Visual Pearls, Cardiovascular, Environmental, Expert Peer Reviewed (Clinical), Tox & Medications|

Which cardiotoxic plant is shown? Lily of the valley Moonflower Morning glory Water hemlock White snakeroot [+]

Sheila Goertemoeller, PharmD, DABAT, ICPS

Sheila Goertemoeller, PharmD, DABAT, ICPS

Clinical Toxicologist and Educator
Drug and Poison Information Center
Cincinnati Children's Hospital Medical Center
Sheila Goertemoeller, PharmD, DABAT, ICPS

Latest posts by Sheila Goertemoeller, PharmD, DABAT, ICPS (

  • cone snail shell botulinum

ACMT Toxicology Visual Pearl: Marcel the Shell with Toxins

By |Categories: ACMT Visual Pearls, Dermatology, Environmental, Expert Peer Reviewed (Clinical), Tox & Medications|

The venom from this pictured snail shares a primary mechanism of action with what other deadly toxin? Alpha-latrotoxin Botulinum toxin Bufotoxin Tetanus toxin Sarin [+]

Aaron Frolichstein, MD

Aaron Frolichstein, MD

Resident
Department of Emergency Medicine
Carolinas Medical Center
  • black eschar anthrax

ACMT Toxicology Visual Pearl: The Black Eschar

By |Categories: ACMT Visual Pearls, Dermatology, Expert Peer Reviewed (Clinical), Tox & Medications|

Which of the following is the most likely explanation for this skin lesion in a worker handling sheep hides? Bacillus anthracis Group A streptococcus Pseudomonas aeruginosa Staphylococcus aureus (Photo credit: CDC/ James H. Steele, Public domain via Wikimedia Commons) [+]

Alex Blackwell, MD

Alex Blackwell, MD

Resident
Department of Emergency Medicine
Carolinas Medical Center
Alex Blackwell, MD

Phenobarbital as First-Line Medication for Alcohol Withdrawal: Have You Switched From Benzodiazepines Yet?

By |Categories: Neurology, Tox & Medications|

Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? If not, you probably should be. Another old drug for a new indication, right? Well not exactly. Phenobarbital is indeed an older and relatively cheap drug (less than $20 per loading dose) that has gained some press recently for the treatment of acute alcohol withdrawal [1-3]. Why should you consider using phenobarbital as monotherapy rather than benzodiazepines? Phenobarbital used to be one of the standard treatments for ethanol (EtOH) withdrawal prior to the introduction of benzodiazepines. However, there [+]

Trick of Trade: Dual Foley catheter to control massive epistaxis

By |Categories: Genitourinary, Pediatrics, Tricks of the Trade|

Massive epistaxis is considered a medical emergency that requires immediate attention. Symptoms of massive epistaxis include sudden and heavy bleeding from the nose, difficulty breathing, dizziness, and a rapid heartbeat. If left untreated, it can lead to significant blood loss, shock, airway obstruction, and even death. We report a case of a 50-year-old man with end stage renal disease with massive nasal bleeding from the left nostril, shortness of breath, and confusion. Initial Management After a rapid assessment, we inserted an anterior nasal pack, soaked in epinephrine, TXA, and an antibiotic-based lubricant. However, the bleeding continued from his nares [+]

Trick of Trade: Removal of Entrapped Metal Zipper

By |Categories: Genitourinary, Pediatrics, Tricks of the Trade|

A young boy is brought to the pediatric emergency screaming at the top of his lungs by his parents. His penile skin is trapped in the zipper of his jeans. On a busy shift, you want a simple way to handle zipper injuries that minimizes pain, doesn't require resource-intensive procedural sedation, and is quick. Background The 4 most common types of zippers are nylon coil zip, plastic mold zip, metal zip, and invisible zip. Most of the techniques describing solutions on zipper entrapment in the medical literature are derived from case reports and case series. All revolve around understanding [+]

  • esophageal balloon manometer trick minnesota blackmore tube

Trick of Trade: Inflating the Esophageal Balloon of a Blakemore/Minnesota Tube without a Manometer 

By |Categories: Critical Care/ Resus, Gastrointestinal, Tricks of the Trade|

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. He looks really bad, stating that he has been vomiting blood. He is hypotensive. He then vomits a copious amount of blood right in front of you. You intubate the patient and initiate the massive transfusion protocol, but everything you pour into him seemingly comes right back out. The gastroenterologist on-call states that he is too unstable for endoscopy. It is time for a balloon tamponade device. You’ve trained for this and set up everything. [+]

SAEM Clinical Images Series: My Eye Looks Different

By |Categories: HEENT, Ophthalmology, SAEM Clinical Images|

A 29 year-old-male with a past medical history of left eye enucleation secondary to a gunshot wound several years prior presents to the Emergency Department (ED) for blurry vision, redness, and concern for a deformity to his right eye. The patient states symptoms started 2-3 months ago and he initially thought symptoms were due to allergies and recalls rubbing his eye a lot. Over the past 3-4 days, he noticed an acute decline in his vision with what the patient describes as a “cloudy bump” appearing during that time. The patient normally does not wear [+]

ALiEM AIR Series | Procedures Module

By |Categories: ALiEMU, Approved Instructional Resources (AIR series), Critical Care/ Resus|Tags: |

Welcome to the AIR Procedures Module! After carefully reviewing all relevant posts in the past 12 months 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 related to procedures in the Emergency Department. 6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. More specifically, we identified 2 AIR and 4 Honorable Mentions. We recommend programs give 3 hours of III credit for this module. AIR Stamp of Approval [+]

Trick of the Trade: Gel-free ultrasound-guided peripheral IV technique

By |Categories: Radiology, Tricks of the Trade, Ultrasound|

Ever finally step away from a busy resuscitation and someone stops you for peripheral IV access? You set up everything, have the patient positioned, and then notice there is no sterile ultrasound gel. No gel? No problem. The trick is to eliminate anything of poor acoustic impedance between the ultrasound probe and the patient's skin. Trick of the Trade 1. Apply a transparent adhesive dressing with a thin alcohol layer on the probe Instead of using gel, we squeeze alcohol pads to create a thin alcohol layer and place a transparent adhesive cover, such as Tegaderm ©. The thin [+]

Shuhan He, MD
ALiEM Senior Systems Engineer;
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Shuhan He, MD