INSTAGRAM

ALiEM is back with another #FBF from #BestOfALiEM: PEM Pearls- Red Flags for Child Abuse⠀

Fractures are a common sign of abuse. It is impossible to tell from an x-ray alone whether or not a fracture is due to abuse. Fractures of the extremities are the most common skeletal injury in children who have been abused and approximately 80% of fractures due to abuse occur in children under 18 months old. In non-mobile children, rib fractures, long bone fractures, and metaphyseal fractures have a high correlation with child abuse. An understanding of the motor development of young children can aid physicians in the identifying fractures due to abuse.⠀

Remember to click the link in bio for full article! 📲⠀

#FOAMEd #FOAM #EmergencyMedicine #MedicalEducation #medicalstudent #patientcare #physicianassistant #nursepractitioner #emergencyroom #residentlife #medschool #Procedures #Emergency #ALiEM #MedEd⠀

https://www.aliem.com/pem-pearls-child-abuse-case-2/
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ALiEM is back with another #TrickofTheTradeTuesday: Ultrasound for Pedal Pulse Identification and ABI⠀

The Problem: A patient is rolled in to your ED by EMS with extremity trauma. You’re rightfully concerned about possible vascular injury to an upper or lower extremity, but you can’t palpate a dorsalis pedis (DP) or posterior tibialis (PT) pulse! You spend minutes, whisking the doppler probe, attempting to hear a waveform in a busy ED. Unfortunately you can’t seem to hear the “whoosh,” making accurate it nearly impossible for you to measure ankle-brachial indices (ABI).⠀

💥💥Find and mark your pedal pulses using ultrasound💥💥 ⠀

Remember to click the link in bio for full article! 📲 ⠀

#FOAMEd #FOAM #EmergencyMedicine #MedicalEducation #medicalstudent #patientcare #physicianassistant #nursepractitioner #emergencyroom #residentlife #medschool #Procedures #Emergency #ALiEM #MedEd ⠀

https://www.aliem.com/trick-ultrasound-pedal-pulse-identification-abi/
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ALiEM is back with another #FBF from #BestOfALiEM: PEM Pearls- 5 Tips to Demystify Amoxicillin in Pediatric Infections⠀

Amoxicillin is a penicillin derivative antibiotic against susceptible gram positive and gram negative bacteria. It has reasonable coverage for most upper respiratory infections and is used as prophylaxis for asplenia and bacterial endocarditis. This post aims to demystify amoxicillin treatment for common pediatric infections.⠀

CAP and AOM: High-dose amoxicillin (to overcome bacterial resistance) is prescribed 80-90 mg/kg/day divided into 2 doses⠀

Group A Strep pharyngitis: 50 mg/kg/day, once a day (to prevent rheumatic fever)⠀
Amoxicillin-clavulanate: Use if AOM treated in last 30 days, AOM with purulent conjunctivitis, 3+ episodes of AOM in 6 months, or 4+ episodes of AOM in 12 months⠀

Counseling: Educate parents/guardians on potential adverse effects with amoxicillin:Rashes (due to IgE-mediated or delayed hypersensitivity reactions or to Ebstein-Barr virus co-infection)⠀

If any signs of anaphylaxis, take to an ED immediately.⠀

Remember to click the link in bio for full article! 📲⠀

#FOAMEd #FOAM #EmergencyMedicine #MedicalEducation #medicalstudent #patientcare #physicianassistant #nursepractitioner #emergencyroom #residentlife #medschool #Procedures #Emergency #ALiEM #MedEd⠀

https://www.aliem.com/pem-pearls-5-tips-amoxicillin-pediatric-infections/
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ALiEM is back with another #TrickofTheTradeTuesday: L5 medial hamstring reflex⠀

Traditionally in medical school, it is taught that lower extremity deep tendon reflexes for L4 and S1 nerve root levels can be elicited by tapping on the patella and Achilles tendons. It was just taught that L5 didn’t have a reflex to check. Knowing if an L5 radiculopathy existed would be especially helpful when assessing a patient for a potential lumbar disc herniation where a careful lower extremity neurologic exam is important. It turns out one can actually check for a L5 reflex. ⠀

The authors of a 2012 study, which enrolled 100 consecutive patients with documented lumbar disc herniations, studied the accuracy rate of the patellar, medial hamstring, and Achilles reflexes to identify the correct disc level:⠀

Patella (L4): 86%⠀
Medial Hamstring (L5): 79%⠀
Achilles (S1): 67%⠀

Remember to click the link in bio for full article! 📲 ⠀

#FOAMEd #FOAM #EmergencyMedicine #MedicalEducation #medicalstudent #patientcare #physicianassistant #nursepractitioner #emergencyroom #residentlife #medschool #Procedures #Emergency #ALiEM #MedEd ⠀

https://www.aliem.com/trick-trade-l5-medial-hamstring-reflex/
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ALiEM is back with another #FBF from #BestOfALiEM: Gaining the Diagnosis of Vitreous Hemorrhage with Ultrasound⠀

A 54 year-old male presents to the emergency department with an eye complaint. The patient works as a cook and while cleaning the grill several hours ago felt something fly into his eye. He did not immediately feel pain, but notes blurred vision and an increasing pressure-like sensation in his left eye. He describes his left-sided blurred vision as a haziness, like cobwebs over his eye. He has been able to open his eye and keep it open without difficulty.⠀

The ultrasounds above demonstrate classic findings for vitreous hemorrhage, in which the posterior chamber contains materials of varying echogenicity. The vitreous humor is an avascular gel-like substance that occupies the space between the lens and the retina in the eye. Vitreous hemorrhage occurs when extravasated blood enters here often due to three main causes: Diabetic retinopathy, vitreous detachment (with or without retinal detachment), or ocular trauma (ie foreign body or shaken baby syndrome). Visual acuity and retention of macular function depend on the extent of hemorrhage; as little as 12.5 microliters of blood can cause vision changes or painless vision loss.⠀

Patients will present complaining of unilateral painless vision changes described as a hazy fog. Orbital pain and pain with extraocular movements may also be seen in cases caused by trauma. On physical exam, patients may have a decreased red reflex on ophthalmoscopic examination. If left untreated, patients may experience retinal detachment, glaucoma and/or permanent vision loss.⠀

Remember to click the link in bio for full article! 📲⠀

#FOAMEd #FOAM #EmergencyMedicine #MedicalEducation #medicalstudent #patientcare #physicianassistant #nursepractitioner #emergencyroom #residentlife #medschool #Procedures #Emergency #ALiEM #MedEd #opthamology #eyeanatomy⠀

https://www.aliem.com/gaining-diagnosis-vitreous-hemorrhage-ultrasound/
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ALiEM is back with another #TrickofTheTradeTuesday: Tracheostomy leak temporization ⠀

Patients who are tracheostomy and ventilator dependent are at increased risk for complications the longer they remain in this condition. One common complication is tracheomalacia. Progressive tracheomalacia can lead to air leaks around the tracheostomy cannula balloon. Initially, this can be managed by placing a longer tracheostomy cannula deeper into the trachea, however, these are often unavailable in the emergency department [1]. A second line strategy is to temporarily over-inflate the balloon, however, with chronic overinflation, eventually both the trachea and the neck stoma become too large, leading to an inability to maintain appropriate positive pressure (PEEP) and tidal volume necessary to ventilate the patient.⠀

💥💥Trick: Duoderm patch💥💥 ⠀

Remember to click the link in bio for full article! 📲 ⠀

#FOAMEd #FOAM #EmergencyMedicine #MedicalEducation #medicalstudent #patientcare #physicianassistant #nursepractitioner #emergencyroom #residentlife #medschool #Procedures #Emergency #ALiEM #MedEd ⠀

https://www.aliem.com/trick-of-trade-tracheostomy-leak-temporization/
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ALiEM is back with another #TrickofTheTradeTuesday: A cleaner way to apply dental cement for a tooth fracture ⠀

The management of a dental fracture is a core skill of the emergency physician.1 When the enamel is violated and the underlying dentin is exposed (i.e. Ellis Class II or greater), the dental pulp becomes at risk.2 Protecting the exposed dentin in a timely manner, therefore, is paramount. This is best accomplished through the use of dental cements.⠀

The application of dental cement to a fractured tooth, while a relatively rare procedure, is one often fraught with difficulties. With many of the formulations requiring the rapid application of a fast-drying cement, time for accurate and clean application is limited. This often clumsy, haphazard spackling of the patient’s tooth with cement rarely feels smooth or confidence-instilling. Isn’t there a better way?⠀

Remember to click the link in bio for full article! 📲 ⠀

#FOAMEd #FOAM #EmergencyMedicine #MedicalEducation #medicalstudent #patientcare #physicianassistant #nursepractitioner #emergencyroom #residentlife #medschool #Procedures #Emergency #ALiEM #MedEd ⠀

https://www.aliem.com/trick-apply-dental-cement/
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ALiEM is back with another case from the SplintER Series: The Recurrent Shoulder Dislocation ⠀⠀
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A 17 year-old football player with prior shoulder dislocation presents to the emergency department reporting shoulder pain after fall. You obtain shoulder x-rays and see the following injury.⠀

What is your diagnosis? Are there any associated lesions you could expect to find? What is your emergency department management?⠀
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Click Link in Bio for Answers! 📲⠀

https://www.aliem.com/splinter-series-recurrent-shoulder-dislocation/
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ALiEM is back with another #TrickofTheTradeTuesday: Directed Saline Irrigation for Nasal Suctioning⠀

You are just starting out your mid-January evening shift, and you go to the room of an 8-month old male with nasal congestion. He is afebrile, and mildly tachycardic, but his lung exam is fairly benign and he’s breathing easily without retractions. You can clearly see he has congestion. You instruct the parents to use saline irrigation and then nasal suctioning to clear the congestion as needed, and they say, “How can we do this if our child struggles? Won’t we just end up with a wet, angry, and congested child?”⠀

💥💥Connect an angiocath tip to a J-Loop, and then attach directly to a saline flush. Connect these together, and now you have a system which you can use to direct the saline into the nostril of a struggling infant. Hold the base of one hand against the patient’s cheek, and with two fingers direct the angiocath tip into the nostril. With the other hand, you hold the flush.⠀

Use your left forearm to hold down the baby’s right arm, and your right forearm to hold down the baby’s left arm, preventing the patient from pushing things out of the way.💥💥 ⠀

Remember to click the link in bio for full article! 📲 ⠀

#FOAMEd #FOAM #EmergencyMedicine #MedicalEducation #medicalstudent #patientcare #physicianassistant #nursepractitioner #emergencyroom #residentlife #medschool #Procedures #Emergency #ALiEM #MedEd ⠀

https://www.aliem.com/trick-of-trade-directed-saline-irrigation/
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ALiEM is back with the latest from teh @saemonline Clinical Image Series: Fever and Aches⠀

A 62 year old female with no past medical history presented to the ED with fevers, generalized weakness, severe muscle aches, and a rash. She had returned home from the Philippines 3 days prior to evaluation. Twenty-four hours prior to arrival, the patient noticed a rash on her shins. She denied any nausea, vomiting, diarrhea, abdominal pain, chest pain, shortness of breath, cough, sore throat, dysuria, urinary frequency, headache, and neck pain. The patient was in the Philippines for a family funeral and was indoors for most of the trip. She was unsure if she was stung by any bugs or mosquitos.⠀

WHAT IS THE DIAGNOSIS? Comment or tag a friend who would know!⠀

Remember to click the link in bio for full article! 📲our⠀

#FOAMEd #FOAM #EmergencyMedicine #MedicalEducation #medicalstudent #patientcare #physicianassistant #nursepractitioner #emergencyroom #residentlife #medschool #Procedures #Emergency #ALiEM #MedEd⠀

https://www.aliem.com/saem-clinical-image-series-fever-aches/
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ALiEM is back with and incredibly SIMPLE but effective #TrickofTheTradeTuesday: Needle-vein alignment in ultrasound guided peripheral IV⠀

Placing a peripheral IV under ultrasound guidance is often much more challenging than it outwardly appears, especially for novice users. One of the more difficult aspects is in making sure that the target vessel is perfectly in the middle of the screen and then guessing where that corresponds to the middle of the ultrasound probe.⠀

💥💥Use the M-mode line to optimize needle-vein alignment💥💥 ⠀

Remember to click the link in bio for full article! 📲 ⠀

#FOAMEd #FOAM #EmergencyMedicine #MedicalEducation #medicalstudent #patientcare #physicianassistant #nursepractitioner #emergencyroom #residentlife #medschool #Procedures #Emergency #ALiEM #MedEd ⠀

https://www.aliem.com/trick-of-trade-needle-vein-alignment-in-ultrasound-guided-peripheral-iv/
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Have you ever been working a shift at 3 AM and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This is a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify common and catastrophic injuries. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. Check out the amazing review by @villa.stephen focused on wrist injuries. ⠀

Can you identify the five "can't miss" wrist injuries above? ⠀

Remember to click the link in bio for full article! 📲 ⠀

#FOAMEd #FOAM #EmergencyMedicine #MedicalEducation #medicalstudent #patientcare #physicianassistant #nursepractitioner #emergencyroom #residentlife #medschool #Procedures #Emergency #ALiEM #MedEd ⠀

https://www.aliem.com/emrad-adult-wrist-cant-miss/
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ALiEM is back with another #TrickofTheTradeTuesday: Linear Ultrasound Transducers in Intrauterine Pregnancy Evaluation 🤰🏾 ⠀

The selection of POCUS as the initial imaging test compared to a radiology pelvic ultrasound (US) led to a 120-minute reduction in average ED length of stay in one single center randomized study.1 Typically these POCUS exams are performed using a standard low-frequency, transabdominal curvilinear probe. Resolution of the low-frequency curvilinear transducer limits identification of IUP if <6-7 weeks gestation, with a majority of literature estimating approximately 20% failure rate.⠀

💥💥The next time you may be imagining a yolk sac within a gestational sac with the curvilinear probe on POCUS, remember the magnifying glass in your back pocket – a high-frequency linear transducer.💥💥 ⠀

Remember to click the link in bio for full article! 📲 ⠀

#FOAMEd #FOAM #EmergencyMedicine #MedicalEducation #medicalstudent #patientcare #physicianassistant #nursepractitioner #emergencyroom #residentlife #medschool #Procedures #Emergency #ALiEM #MedEd #OBGYN #ultrasound #POCUS ⠀

https://www.aliem.com/trick-of-the-trade-using-linear-transducers-for-point-of-care-ultrasound-in-intrauterine-pregnancy-evaluation-no-inline/
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ALiEM is back with another case from the SplintER Series: A Rare Cause of Traumatic Thumb Pain⠀
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A 45 year-old male presents with right thumb pain and deformity after falling off his bicycle. You obtain hand x-rays and see the following images. What is the most likely diagnosis and radiologic diagnosis? What is your management plan?⠀
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Click Link in Bio for Answers and an amazing review of this rare injury 📲⠀⠀
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#FOAMEd #FOAM #EmergencyMedicine #MedicalEducation#medicalstudent #patientcare #physicianassistant#nursepractitioner #emergencyroom #residentlife #medschool#Procedures #Emergency #ALiEM #MedEd⠀⠀

https://www.aliem.com/thumb-pain-from-cmc-dislocation/⠀
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Also check out the Instagram feed by Dr. Michelle Lin.