ED Charting and Coding: Review of Systems
Editor’s Note (Jan 13, 2023): The new AMA CPT 2023 Documentation Guidelines have been published and the prior Review of Systems section is no longer incorporated into the billing and coding guidelines. See the ACEP FAQ page on the 2023 Emergency Department Evaluation and Management (E/M) Guidelines. The Review of Systems (ROS) was the most frustrating aspect of charting as an intern. Documenting at least 10 elements from systems seemingly unrelated to the chief complaint took as long as a physical exam and was much harder to remember. For efficiency, many of us include any pertinent positives and negatives [+]
New ALiEM turquoise socks now for sale
In anticipation of the upcoming holidays, we have a stock of brand new ALiEM turquoise socks for sale. We gave them out to our core team members at the recent American College of Emergency Physicians (ACEP) Scientific Assembly in 2016. Needless to say, they were a big hit. These are now available for online purchase (along with the remaining few blue ones that we will retire after this last stock runs out). Currently they are only available for purchase and shipment in the United States. Come join our extended ALiEM family! [+]
MEdIC Series: The Case of the Overly Attentive Attending
Welcome to season 4, episode 2 of the ALiEM Medical Education in Cases (MEdIC) series! Our team (Drs. Tamara McColl, Teresa Chan, John Eicken, Sarah Luckett-Gatopoulos, Eve Purdy, and Brent Thoma) is pleased to welcome you to our online community of practice where we discuss the practice of academic medicine! In this month’s case, a junior resident feels violated and shamed after a sexually aggressive encounter with an orthopedic attending physician. [+]
Magnesium for Rapid Atrial Fibrillation Rate-Control in the ED
We love magnesium in the Emergency Department. It’s been said that magnesium is second-line for everything (kind of like doxycycline). But what about rate/rhythm control in atrial fibrillation (AF)? The 2014 AHA/ACC/HRS guideline for the management of patients with AF doesn’t mention magnesium at all.1 Dr. Josh Farkas (@PulmCrit) wrote about magnesium infusions for atrial fibrillation and torsade last year. His post looked at its use for cardioversion, rhythm-control, and rate-control in critically-ill patients. Our post will focus specifically on the IV magnesium data for rate-control in ED-related settings. [+]
IDEA Series: The “Knowledge Bomb” Highlights Clinically Relevant Research
The Problem Residents continually face the challenge of keeping up to date with relevant medical literature in the midst of the rigors of completing medical residency. In addition, application of new medical knowledge obtained from reviewing recent research can be challenging and is a difficult skill to teach. Residency provides a unique experience for individual learners based on each learner’s personal interests, interactions with other learners and faculty, and patient encounters. Often, residents achieve their best research and article discovery when prompted by specific patient encounters. A forum for individual residents to share knowledge gained from research prompted by these encounters [+]
52 Articles in 52 Weeks (2nd edition, 2016)
Maintaining lifelong learning is challenging, especially when trying to keep up with all of the journal publications in emergency medicine (EM). In 2013, we published a compilation of 52 journal articles, which interns could read over a 52-week period, at an average pace of 1 journal article per week. In the list below, we present an updated compilation for the “52 Articles in 52 Weeks” initiative. [+]
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Whipped Cream Charger Abuse: The Toxicologist Mindset
The Toxicologist Mindset series features real-life cases from the San Francisco Division of the California Poison Control System. Case: A 39-year-old man, with no significant past medical history, was brought to the emergency department by family members, over three consecutive days, for anxiety, confusion, and ataxia. In the first two visits, his laboratory work-up, including complete blood cell count, chemistry panel, liver function tests, urine drug screen, and non-contrast head CT, were unremarkable. On his third visit, he was profoundly encephalopathic with confusion and poor concentration. He had bilateral lower extremity weakness and ataxia. He was admitted to the neurology [+]
ALiEM Book Club: On The Move
“I am a storyteller, for better and for worse. I suspect that a feeling for stories, for narrative, is a universal human disposition, going with our powers of language, consciousness of self, and autobiographical memory.” —Oliver Sacks, On the Move Oliver Sacks has been many things in his life—physician, writer, researcher, drug addict, power lifter, motorcycle lover. He writes about all of these experiences as they have arced across the course of his much varied life in his memoir, On the Move [Amazon]. In this colorful autobiography, Sacks bobs and weaves through his own life, at times focusing in on [+]
Introducing CME for ALiEM via FOAMbase
Ever wish you could get Continuing Medical Education (CME) credit for the Free Open Access Meducation (FOAM) you already consume? We are excited to announce that 10 ALiEM articles are now available for AMA PRA Category 1 CME. This is a pilot program in collaboration with FOAMbase and EB Medicine. There is great content on trauma, geriatrics, pediatrics, critical care, and more. We think CME for FOAM is going to be a great way to increase sustainability for FOAM authors while keeping FOAM 100% free and open access. [+]
MEdIC: Case of Cognitive Overload – Expert Review and Curated Community Commentary
The Case of Cognitive Overload outlined a scenario of a junior resident dealing with the harsh realities of working in emergency medicine when she experiences the negative impacts of cognitive overload while caring for a sick patient. This month, the MEdIC team (Tamara McColl, Teresa Chan, Sarah Luckett-Gatopoulos, Eve Purdy, John Eicken, and Brent Thoma), hosted a discussion around this case with insights from the ALiEM community. We are proud to present to you the Curated Community Commentary and our 2 expert opinions. Thank-you to all participants for contributing to the very rich discussions surrounding this case! [+]