New PECARN Febrile Infant Rule: A 3-Variable Approach for Ages 29-60 Days | Interview with Dr. Kuppermann

By |Categories: Pediatrics|Tags: |

The diagnosis and risk stratification of febrile young infants continues to present a clinical challenge. Serious bacterial infection (SBI) rates in infants ≤60 days have continued to be reported between 8-13%. Despite several different classification rules and pathways, we continue to struggle to accurately delineate which infants have SBI and which do not. A paper titled “A Clinical Prediction Rule to Identify Febrile Infants 60 days and Younger at Low Risk for Serious Bacterial Infections” was published in JAMA Pediatrics in February of 2019.​1​ The authors sought to derive a new clinical prediction rule for infants with fever. The research [...]

SAEM Clinical Image Series: Dysphagia and Dyspnea in a Well Digger

By |Categories: Pulmonary, SAEM Clinical Images|

[Click for larger view] Chief Complaint: Pain with swallowing History of Present Illness: A 43-year-old male presented to the emergency department with progressing pain upon swallowing. He described a sensation of food becoming stuck and creating a fullness in his chest. Review of symptoms was positive for dyspnea on exertion worsening over several months, but negative for cough, fevers, or weight change. He reported no medical history and had recently emigrated from Guatemala where he worked as a well digger. […]

SplintER Series: A Case of Severe Shoulder Pain

By |Categories: Orthopedic, SplintER|

A 45 year old woman presents with several days of gradually worsening right shoulder pain and stiffness. Her shoulder is very warm to the touch but not erythematous. You obtain shoulder x-rays and see a linear density in the AP view (photo credit). What is the most likely diagnosis, the differential diagnosis, and management plan?   […]

  • warm ultrasound gel

Ultrasound Gel Warmers in the Emergency Department?

By |Categories: Infectious Disease, Ultrasound|

How many times have you told a patient “The gel will be cold?” How many times have you watched a patient retract from the transducer because of the cold gel? How about a pediatric patient? Could warm gel improve your rate of clinically successful scans? It seems easy enough to install gel warmers alongside our ultrasound machines. But, should we do this? Read more

SplintER Series: Case of a First Metacarpal Fracture

By |Categories: Orthopedic, SplintER|

Click image to enlarge view A 22 year-old male was playing football when he fell, landing on his outstretched left arm with his thumb flexed. He now has pain at the base of his thumb. This AP view of the hand best demonstrates the injury (photo credit). What is this fracture, what additional imaging is needed, and what should be the management plan?     […]

ALiEM AIR | Neurology 2019 Module

By |Categories: ALiEMU, Approved Instructional Resources (AIR series), Neurology|

Welcome to the Neurology 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 neurological emergencies. 6 blog posts within the past 12 months (as of January 2019) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 1 AIR and 5 Honorable Mentions. We recommend programs give 3 hours (about 30 minutes per article) of III credit for this module. […]

DIY Ultrasound Model Compendium in Emergency Medicine

By |Categories: Ultrasound|

As the use of point-of-care ultrasound expands in emergency medicine, phantoms offer an attractive training solution for new learners and continuing education. Unfortunately, commercially available products are expensive and likely cost-prohibitive for individual practitioners to purchase. Luckily, there are a number of quality, low cost do-it-yourself (DIY) models published in journals and on the Internet. To help you navigate your options, I have created a compendium of DIY ultrasound models relevant to emergency medicine. The models are divided by system or application with a cost estimate for each model, if provided, as well as a list of materials and a [...]

Guideline Review: ACEP 2018 – ED Procedural Sedation with Propofol

By |Categories: Guideline Review, Tox & Medications|Tags: , |

The last American College of Emergency Physicians (ACEP) guideline recommendations regarding the use of propofol for ED procedural sedation was in 2007. Much research has since demonstrated its safety in adults and children. Furthermore, many clinicians are co-administering ketamine or fentanyl in conjunction. This 2018 ACEP update​1​ addresses these issues and much more. The following infographic summarizes the key points. […]

Health Insurance 101 for the Emergency Physician

By |Categories: Public Health, Public Policy|

A 28 year-old single man with type I diabetes mellitus presents to your busy Texas emergency department in diabetic ketoacidosis (DKA). This is his third hospitalization for DKA in 5 months. When you ask the patient about his current medication regimen, he admits that he frequently skips doses as a cost-savings measure. He shares that he works 45 hours a week at a small local grocery store, makes minimum wage ($15,660 pretax), and has no health insurance. His prescribed insulin regimen, consisting of Lantus at bedtime and Humalog with meals, costs approximately $600 a month. [...]