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 [+]
MEdIC: Case of the Night Shift Stimulants – Expert Review and Curated Community Commentary
Our fifth case of season 5, The Case of the Night Shift Stimulants, presented the scenario of a junior emergency medicine (EM) resident who witnesses her attending physician taking stimulants in order to function during his night shift. The MEdIC team (Drs. Tamara McColl, Teresa Chan, Sarah Luckett-Gatopoulos, Eve Purdy, John Eicken, Alkarim Velji, and Brent Thoma), hosted an online discussion around the case over the last 2 weeks with insights from the ALiEM community. We are proud to present to you the curated commentary and our expert opinions. Thank-you to all participants for contributing to the very rich discussions surrounding [+]
SplintER Series: Complications & Discharge Care Plans With Splints 103
In this SplintER Series, we review splinting fundamentals, introduce advanced concepts, and highlight ways to implement these into your next shift. In SplintER 102, we reviewed the materials used in splinting and a general approach to applying a splint. Today’s post puts the spotlight on some of the potential complications of splinting, discharge care plans, and pharmacological adjuncts to aid in recovery. [+]
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Renal Colic & Pulmonary Embolism CT | Reducing Imaging: ACEP E-QUAL Network Podcast
Computed tomography (CT) is increasingly available across U.S. Emergency Departments and has changed the practice of medicine. However, it is coupled with potential side-effects from radiation and contrast media. Emergency Medicine is beginning to make a concerted effort to identify clinical scenarios in which CT may be unnecessary, producing outcomes research and validated clinical decision rules. Renal colic and pulmonary embolism, in particular, seem amenable to this area of investigation. The ACEP E-QUAL Network podcast, a partnership with ALiEM to promote clinical practice improvements, reviewed this topic with experts Dr. Chris Moore (Emory University) and Dr. Jeffrey Kline (Indiana University). We present highlights [+]
ALiEM AIR Series: Environmental Module
Welcome to the Environmental 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 environmental emergencies. 3 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 0 AIR and 3 Honorable Mentions. We recommend programs give 1 hour (about 20 minutes per article) of III credit for this module. [+]
ACMT Toxicology Visual Pearls: Drug-Induced Rash
Two patients with substance-use disorder present to an ED in the United States with a new rash. Which of the following is the most likely exposure? Krokodil (desomorphine) Levamisole-adulterated cocaine Methamphetamine-induced allergic reaction Wound botulism secondary to heroin use [+]
Jennifer S. Love, MD
Department of Emergency Medicine
University of Pennsylvania
Intravenous lidocaine for renal colic
Pain management in the ED has become a balancing act. EPs must continually balance adequate pain management with the risks of opioids prescribing. As providers reach into their pain management toolbox it is always nice to have as many options as possible because one size does not fit all. Specifically for the management of acute renal colic, IV preservative-free (cardiac) lidocaine has been gaining popularity as a potential alternative when opioids are unable to get job done or are contraindicated due to co-morbidities or a history of addiction. Is it safe? Does it work? [+]
PEM Pearls: Pediatric Ultrasound-Guided Peripheral IV Access
Pediatric patients are not just little adults. Placing peripheral IVs in young patients can be challenging and comes with its own set of challenges. Presented are some basic and advanced tips to maximize success in establishing peripheral IV access in pediatric patients using ultrasonography. [+]
William White, MA MD
Department of Emergency Medicine
University of California, San Francisco
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)
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- A Tale of Two Epidemics: COVID-19 and the Opioid Crisis - April 23, 2020