Trick of the Trade: DIY Squirt Bottle Wound Irrigation
Wound irrigation is arguably one of the most important steps in closing a laceration, because all lacerations should be considered to be contaminated. Irrigation is considered the foundation in preventing infection. A common way to cleanse a wound is to irrigate a wound using a 20 cc syringe, angiocatheter, and splash protector. To achieve 500 cc of irrigation, however, it would require 25 syringe refills! Is there a better, cost-effective alternative? [+]
ALiEM Book Club: And The Band Played On
With consistent, adequate treatment, people with HIV have a life expectancy that is nearly normal. However, because HIV often affects the most vulnerable people in our society, getting that consistent treatment remains a real and important challenge. 30 years after And the Band Played On was first published, HIV/AIDS is now often viewed as a chronic illness, rather than the terminal diagnosis it was in the 1980s. For those born after the first AIDS deaths occurred in the US, it can be hard to imagine the fear, denial, stigma, and confusion that accompanied the early AIDS epidemic. Randy Shilts’ And [+]
ALiEM’s Greatest MEdIC Hits for New Senior Residents: A Curated Collection of 10 Cases
While we congratulated and welcomed the interns with the list of Greatest Hits for Interns, it’s high time we actually congratulate and welcome you… the new Senior Residents! You’ve toiled through call shifts on off-service rotations, you’ve worked hard reviewing cases with junior residents and getting grilled you about the latest esoteric facts by the seniors! And now, you’re going to be in charge of other other residents!?! You are probably equal parts excited and scared… but more to the point you may be wondering – How does one actually be a great senior resident? Well we have some resources for you! [+]
Trick of the Trade: Gaze Testing Using “Selfie Mode” on Your Smartphone Camera
The NIH Stroke Scale is used to assess the severity of a suspected stroke. It includes 11 neurologic exam components that can be quickly performed at the bedside. The second component of the NIH Stroke Scale is testing of voluntary horizontal eye movements, a.k.a., “best gaze”.1 Gaze is usually tested by instructing the patient to follow the examiner’s hand or pointer finger in a horizontal plane from side to side. This assessment assumes that the patient can comprehend instructions and actively participate in the physical exam. But… how do you test gaze if your patient is aphasic or unable to [+]
ALiEM’s Greatest Hits for Interns: A Curated Collection of High-Yield Topics
Congratulations, you’ve made it! On July 1, thousands of medical students across the country made the transition to becoming Emergency Medicine residents. It was a particularly competitive year for Emergency Medicine, with 99.7% of first-year spots filled despite a whopping 2,047 positions being offered in 2017 (up by 152 spots compared to last year).1 Now begins the most crucial 3 or 4 years of your medical training that will prepare you for the rest of your career in Emergency Medicine. [+]
Management of Major Pelvic Trauma
Pelvic trauma frequently is associated with other injuries from the high force required to break the pelvis. Management is focused on stabilizing the pelvis and stopping the bleeding. Due to other injuries requiring emergent surgical stabilization, pelvic trauma is primarily managed surgically with pre-peritoneal packing and external fixation, followed by angioembolization for continued bleeding. Emergency physicians must quickly resuscitate patients while gathering vital information to direct the correct definitive bleeding control strategy. New endovascular techniques such as REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) may change future emergency department strategies and improve mortality in severe pelvic trauma. [+]
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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