INSTAGRAM

The 2020 ACLS guidelines provide recommendations on the medication-specific management for arrhythmias including wide-complex tachycardia, regular narrow-complex tachycardia, atrial fibrillation/flutter, and bradycardia. There are also our 2020 ACLS guideline summaries on vasopressor and non-vasopressor medications used during cardiac arrest and toxicology-related conditions. Check out the latest recommendations for tachycardia and click on link in bio for full review!⠀

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

https://www.aliem.com/2020-acls-arrhythmias-management/
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In this challenging season, we are thrilled to see the hope and joy of our frontline healthcare workers receiving their COVID-19 vaccines! From our entire team at ALiEM, we thank you for your tireless work and enduring through the exhaustion and loss of this pandemic. ⠀

Share your #covidvaccine photos by tagging @aliemteam for a shout out!⠀

#Vaxup #FOAMEd #FOAM #EmergencyMedicine #MedicalEducation #medicalstudent #patientcare #physicianassistant #nursepractitioner #emergencyroom #residentlife #medschool #Procedures #Emergency #ALiEM #MedEd #VisualMedicine #Medicine
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ALiEM, in conjunction with @SAEMOnline, presents another case from he SAEM Clinical Image Series: Eye Pain After Assault⠀

A 33-year-old male presents with intermittent blurry vision and left eye pain for 3 months, and a left-sided orbital headache for 1 day. He reports getting punched in the left side of the head during an altercation a few months ago. The eye pain is worse with ocular movements and is associated with bilateral conjunctival injection and white/green discharge from the left eye.⠀

The patient was seen at another emergency department 3 months prior for the same symptoms. He was then found to have left-sided proptosis, visual acuity 20/60 in the left eye, no fluorescein uptake, and a normal fundoscopic exam. The patient was instructed to follow up with ophthalmology but did not. The patient denies fevers, chills, dizziness, nausea, vomiting, and abdominal pain.⠀

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DIAGNOSIS:⠀
Normally, carotid-cavernous fistulas present shortly after trauma, but may not become symptomatic until weeks following the traumatic event. In addition, the elevated intraocular pressures, conjunctival injection, and mild proptosis prompt further investigation with advanced imaging. The computed tomography (CT) angiography of the head with intravenous contrast reveals a carotid-cavernous fistula centered at the level of the posterior genu of the left cavernous internal carotid artery with marked dilatation of the bilateral cavernous sinuses, left sphenoparietal sinus, and the left superior ophthalmic vein. Conventional angiography is the gold standard for diagnosis of a carotid-cavernous fistula, but it can be seen on CT/CT angiography or magnetic resonance imaging (MRI)/magnetic resonance angiogram (MRA) of head. Neurosurgery should be consulted after the diagnosis, along with interventional radiology for cerebral angiography.⠀

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 #VisualMedicine #Medicine
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A major development in curbing the opioid epidemic is the introduction of the medication buprenorphine to address opioid addiction. Being able to prescribe this medication, however, requires a special DEA-X Waiver in the United States. Dr. Alister Martin, the Founder of the Get Waivered initiative, is working to reduce the barriers for clinicians to obtain the training and paperwork necessary to obtain this waiver. Dr. Michelle Lin talks with Dr. Martin on this podcast about the backstory of the Get Waivered program, the lowered barriers to obtaining training, and some sneak peaks on what is new on the launching pad for his program.⠀

Interesting fact: Medical students can participate in the free DEA-X waiver training now. The certificate of completion has no expiration date and can be submitted, when eligible for this waiver license.⠀

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 #VisualMedicine #Medicine ⠀

https://www.aliem.com/buprenorphine-get-waivered-initiative-dea-x-waiver/
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ALiEM introduces the amazing Dr. Luz Silverio (@luzychris), Deputy Editor-in-Chief, in our How I Work Smarter Series.⠀

One word that best describes how you work?⠀
Fitfully and obsessively⠀

Current mobile device⠀
Two: an iPhone 8 supplied by my job for clinical work, and an iPhone 10 for home.⠀

Computer⠀
A very old MacBook Air that constantly pings me, requesting “more space.” I keep putting it in larger rooms, but…⠀

What is something you are working on now?⠀
I’ve been working on a series of 5-10 minute talks to be given prior to shifts that I call “Journal Watch Pictionary.” I read journal articles and then illustrate their key points using my own medium-poor quality cartoon illustrations. It’s fun and I like making people guess what I’m trying to draw, especially because I feel like that helps them pay attention and learn. It also keeps people up-to-date with current literature without having to get pedantic.⠀

Click the link in bio for all of Dr. Silverio's work hacks! 📲⠀

#FOAMEd #FOAM #EmergencyMedicine #MedicalEducation #medicalstudent #patientcare #physicianassistant #nursepractitioner #emergencyroom #residentlife #medschool #Procedures #Emergency #ALiEM #MedEd #VisualMedicine #Medicine
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ALiEM, in conjunction with @SAEMOnline, presents another case from he SAEM Clinical Image Series: Strange Eyes⠀

A 3-month-old boy, born full-term via normal spontaneous vaginal delivery to a gravida 2 para 1 mom with negative prenatal labs, presents with abnormal eye movement and position. His parents report 2 days of an increase in bulging of the soft spot, head size, and abnormal eye movement. He has not been able to look at his mother “like he used to.” This is associated with an increase in fussiness, poor feeding, and non-bilious, non-bloody vomiting. He also had increased sleepiness and difficulty waking up for feedings overnight.⠀

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 #VisualMedicine #Medicine ⠀

https://www.aliem.com/saem-clinical-image-series-strange-eyes/
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ALiEM, in conjunction with @SAEMOnline, presents another case from he SAEM Clinical Image Series: An Incidental Findings⠀

A middle-aged man presented after a motor vehicle collision with a logging truck at 55 miles per hour with low back pain. A computed tomography scan (CT) of the abdomen and pelvis at an outside facility showed a burst fracture of the third lumbar vertebra (L3). The patient had no other complaints. Given the fracture, additional CT imaging was done and the above finding was discovered.⠀

After the incidental finding was found, the patient reported a nail gun accident three years prior where he thought it had just recoiled and struck him in the lip and nose, causing a lip laceration and a minor bloody nose. The patient was seen in the emergency department. The laceration was repaired, and he was discharged without imaging. The patient denied any significant residual symptoms or personality changes. The patient had no idea that a nail had discharged from the gun and lodged in his face and brain.⠀

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 #VisualMedicine #Medicine ⠀

https://www.aliem.com/saem-clinical-image-series-an-incidental-finding/
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ALiEM is back with another case from the UFTW Case: 18M with Acute Shoulder Injury⠀
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An 18-year-old male with no past medical history presents to the ED with acute-onset left shoulder pain that occurred just prior to arrival. The patient was involved in a physical altercation in which his left arm was pulled. He felt a “pop” followed by pain in the shoulder. The patient reports that his arm was pulled again a second time, further worsening the pain. He complains of persistent limited and painful range of motion (ROM) of the left shoulder. He has no history of prior shoulder dislocations, fractures, or other musculoskeletal injuries.⠀

On physical examination, the patient’s left shoulder has limited active ROM due to pain but is able to perform abduction of more than 90 degrees, and internal and external rotation of the affected joint. There is tenderness to palpation of the anterolateral aspect of the left shoulder but no redness, significant swelling, or any obvious deformities.⠀

While an x-ray would be the usual initial imaging modality of choice in a patient presenting to the ED with a musculoskeletal injury, there can be delays in obtaining imaging depending on patient volumes, staffing, and resources. Given this, a bedside POCUS of the shoulder was performed using a posterior approach in order to quickly rule out a shoulder dislocation and expedite patient care.⠀
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Click Link in Bio for Shoulder Ultrasound Tips and Tricks! 📲⠀⠀
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#FOAMEd #FOAM #EmergencyMedicine #MedicalEducation#medicalstudent #patientcare #physicianassistant#nursepractitioner #emergencyroom #residentlife #medschool#Procedures #Emergency #ALiEM #MedEd⠀#Ortho #Shoulder⠀

https://www.aliem.com/ultrasound-for-win-acute-shoulder-injury-us4tw/
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ALiEM is back with another #ACMT from #ToxicologyPearl: Case of a Toxic Tea⠀

The plant pictured is used as a tea, powder, or capsule by individuals looking to self-treat pain or opioid use disorder. Patients may develop nausea, vomiting, hallucinations, or other serious clinical effects after ingestion. What compound is contained in this plant?⠀
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ANSWERS:⠀
Kratom is an herbal product that derives from the tree Mitragyna speciosa, native to Southeast Asia, where it has been historically used as a stimulant.Recently it has grown in popularity in western countries for its opioid activity, primarily used to self-treat opioid withdrawal and chronic pain.⠀

Kratom contains over 40 alkaloids, including mitragynine. Mitragynine is primarily a mu-opioid receptor agonist but also has activity at postsynaptic α-2, serotonin, dopamine, adenosine, and additional opioid receptors. Kratom’s neuropsychiatric effects occur rapidly after ingestion and may last 4-6 hours after the exposure. At lower ingestions (approximately 2-6 grams) kratom acts as a stimulant, while larger ingestions predominantly result in sedation and other opioid effects.⠀

The dose-dependent effects of kratom are thought to be due to the dual binding of α adrenergic receptors leading to stimulation and μ opioid receptors causing sedation. Gastrointestinal symptoms including nausea, vomiting, and constipation. Cardiovascular symptoms such as tachycardia and hypertension⠀
Neurologic symptoms including seizures, hallucinations, agitation, psychosis, and coma. Respiratory depression can occur. ⠀

Minor symptoms generally require only supportive care⠀
Naloxone can reverse opioid effects⠀
Benzodiazepines can be used to treat patients with seizures, tachycardia, hypertension, and agitation.⠀

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 #Toxicology⠀

https://www.aliem.com/acmt-toxicology-visual-pearls-a-toxic-tea/
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Also check out the Instagram feed by Dr. Michelle Lin.