ED Charting and Coding: Critical Care Time
After a STEMI activation from the field on Monday morning, the cardiac catheterization team scoops the patient away shortly after the paramedics arrive in the Emergency Department (ED). “Well that was a smooth and seamless resuscitation. The patient was barely in the ED for more than 15 minutes,” you think to yourself. You diligently complete your critical care documentation, noting 20 minutes of critical care time, before seeing your next patient. A few weeks later the chart is bounced back and noted as an erroneous documentation of critical care time. The coding department notifies you that the case will be [+]
MEdIC Series: Case of the Competency Conundrum – Expert Review and Curated Community Commentary
Our final case of this season, The Case of the Competency Conundrum, outlined a scenario of residency competency committee members who are divided in their approach to a superstar R4 resident, Josh, who has already completed the requirements of his training program. They struggle with competing opinions surrounding competency based medical education (CBME) early advancement principles and the importance of continued exposure/service. This month, 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 this case with insights from the ALiEM community. We are proud to present [+]
Ultrasound for the Win! 53M with Right Index Finger Swelling #US4TW
Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real clinical case where point-of-care ultrasound changed the management of a patient’s care or aided in the diagnosis. In this case, a 53-year-old man with history of diabetes mellitus presents with right index finger swelling. [+]
ACMT Toxicology Visual Pearls: Discolored Skin and Urine
A patient is brought to the Emergency Department by EMS (Emergency Medical Services) from a house fire. The patient’s skin and urine are discolored as shown. What is the most likely cause of the discoloration? Acute liver failure An antidote administered by prehospital provider Carbon monoxide poisoning Massive hemolysis [+]
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I am Dr. Rob Orman, Executive Editor of EM:RAP: How I Stay Healthy in EM
Dr. Rob Orman is an emergency physician from Bend, Oregon. When he’s not in the ED, he can be found creating and working on podcasts for the EM:RAP series, for which he is the Executive Editor. From using mindfulness techniques to stay active, Dr. Orman ensures he is mentally in check at the start of each day. Here’s how he stays healthy in EM! [+]
My EpiPen expired! Can I still use it?
The above question is common from patients with a history of an allergic reaction seen for a repeat emergency department visit. The manufacturers of EpiPen caution not to use the pen beyond the expiration date, and if the drug solution becomes discolored (oxidation). But EpiPens are expensive! Is there harm in using the pen beyond the expiration date? What should we tell our patients?1 [+]
PEM Pearls: Treatment of Pediatric Diabetic Ketoacidosis and the Two-Bag Method
Insulin does MANY things in the body, but the role we care about in the Emergency Department is glucose regulation. Insulin allows cells to take up glucose from the blood stream, inhibits liver glucose production, increases glycogen storage, and increases lipid production. When insulin is not present, such as in patients with Type 1 diabetes mellitus (DM), all of the opposite effects occur. [+]
I am Dr. Richard Shoemaker, Emergency Physician and American Ninja Warrior: How I Stay Healthy in EM
Dr. Richard Shoemaker is an emergency physician from Philadelphia. Primarily working overnight shifts in the ED, Dr. Shoemaker has learned how to master the “shift world”. He maintains his fitness by training as an American Ninja Warrior and is an avid rock climber. Here’s how he stays healthy in EM! [+]
MEdIC Series: The Case of the Competency Conundrum
Welcome to season 4, episode 9 of the ALiEM Medical Education in Cases (MEdIC) series! Our team (Drs. Tamara McColl, Teresa Chan, John Eicken, Sarah Luckett-Gatopoulos, Eve Purdy, Alkarim Velji and Brent Thoma) is pleased to welcome you to our online community of practice where we discuss the practice of academic medicine! This month, we present a case of a residency competency committee that has competing opinions surrounding competency based medical education (CBME) advancement principles when faced with a superstar resident who has met the requirements of his program and may complete his training ahead of the usual trajectory. [+]
PECARN Pediatric Head Trauma: Official Visual Decision Aid for Clinicians
The Pediatric Emergency Care Applied Research Network (PECARN) collaborative has teamed up with the ALiEM and CanadiEM teams to introduce the official PECARN visual decision rule aid for pediatric blunt head trauma! This has been a 6 month collaboration focused on bringing evidence-based research to the bedside in pediatric emergency medicine (EM). [+]