Utility of Pre-4-Hour Acetaminophen Levels in Acute Overdose

By |Categories: Tox & Medications|

Case Presentation: A 37 y/o woman presents to the ED with altered mental status. The vital signs are within normal limits. The history is provided by a friend who states that the patient was normal 2 hours ago when they were together. When she returned home, she found the patient in this state next to an empty bottle of acetaminophen (APAP) and 5 empty beer cans. A recent loss in the family has led to some depression in the last few weeks. A battery of labs are sent off including a ‘tox panel’ consisting of serum EtOH, salicylate, and APAP levels. The presumed time of [+]

PV Card: Palliative Care Screening in the Emergency Department

By |Categories: ALiEM Cards, Expert Peer Reviewed (Clinical), Geriatrics|

What is Palliative Care? It is specialized medical care focusing on improving the care and quality of life for patients with advanced illness by decreasing suffering. It can be delivered concurrently with curative care. Early identification of patients who are likely to benefit is key. How do you decide whether your patient could benefit from a palliative care consult?   Hot off the presses We just published in Academic Emergency Medicine a validated screening tool to identify ED patients who would benefit from palliative care [PubMed abstract].1 In an effort to accelerate knowledge dissemination, the checklist is reproduced here in PV card form. Be sure [+]

60-Second Soapbox: New podcast series featuring Drs. Lin, Riddell, Shaikh

By |Categories: 60-Second Soapbox, Genitourinary, Infectious Disease, Medical Education, Podcasts, Trauma|

We are excited to announce our new podcast series, 60-Second Soapbox! Each episode, one lucky individual gets exactly 1 whole minute to present their rant-of-choice to the world. Any topic is on the table – clinical, academic, economic, or whatever else may interest an EM-centric audience. Don’t worry if your are microphone-shy. We will carefully remix your audio to add an extra splash of drama and excitement. Even more exciting, participants get to challenge 3 of their peers to stand on a soapbox of their own! [+]

AIR Series: Respiratory Part 2 (2015)

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

We found an enormous amount of respiratory content and thus have divided the respiratory module into two modules. While the first module focused on general respiratory issues, this second module is focused on airway and pulmonary embolism. Below we have listed our selection of the 15 highest quality blog posts within the past 12 months (current as of March 2015) related to respiratory, curated and approved for residency training by the AIR Series Board. In this module we have 4 AIRs and 11 Honorable Mentions. We strive for comprehensiveness by selecting from a broad spectrum of blogs from the top 50 listing per the Social Media [+]

Assessing and Managing Delirium in Older Adults

By |Categories: Geriatrics, Neurology|

Every day in the Emergency Department we see older adults with dementia who have developed delirium and are brought in because of worsening agitation, combativeness, or confusion. In order to care for them, we have to consider what the underlying cause of their agitation may be, but we also have to protect the patient and staff in case of violent outbursts. Older adults experience a phenomenon termed ‘homeostenosis’ in which their physiologic reserve and the degree to which they can compensate for stressors is narrowed, putting them at risk for delirium. This post will outline [+]

Poll : How do you use the PV cards?

By |Categories: ALiEM Cards|

In our effort to take the Paucis verbis (PV) card series to the next level, we are interested in knowing how YOU use the cards.  We would appreciate your answers to the following 4 questions. Also if you have any comments/suggestions regarding the PV cards and how we can make them better please, use the Comments section.   [+]

Catherine Patocka, [+]</p></body></html>

EMS Fellowship: 10 Questions I Wish Applicants Would Ask the Fellowship Director

By |Categories: EMS, Medical Education|

Well, it is EMS fellowship interview season again, and every year after the lovely encounter with very well qualified candidates, I am left wondering if they have achieved a good return on their investment of time and money coming to visit us. Did they really get a good idea of the important aspects of our program, or will they just have to make an educated guess about whether they would be happy spending a year or more with us? [+]

Considering a Medical Toxicology Fellowship?

By |Categories: Medical Education, Tox & Medications|

Every year, EM residents ponder whether to do a fellowship. In the ALiEM Chief Resident Incubator, a handful are very interested in a medical toxicology fellowship, but I woefully am unqualified to provide any advice. So in a “phone a friend” moment, I boldly sent out an email requesting advice and insights. I received two amazing replies from Dr. Lewis Nelson (NYU) from a fellowship director’s perspective and Dr. Annie Arens (UCSF) from a fellow’s perspective. [+]

Trick of the Trade: Squeeze test for confirmation of IO placement

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

Venipuncture is the most common invasive procedure performed in the emergency department 1 , likely due to the fact that the vast majority of our laboratory evaluations require blood and many of our life saving interventions require access to the patient’s systemic circulation. Most of the time emergency department staff are able to perform this procedure easily, but occasionally you find that your patient is the dreaded “difficult stick”. Literature suggests that the landmark technique is successful on the initial venipuncture 74-77% of the time. 2–5  Success rates rise after multiple attempts, but what happens when you don’t have the luxury [+]

Shuhan He, MD

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