Tips for Interpreting the CSF Opening Pressure
In Emergency Medicine, we are like Goldilocks when it comes to many things: We don’t like a patient’s PaO2 to be too high or too low. We don’t like the bed too high or too low when we intubate. We get concerned when we see a potassium that is too high or too low. The Goldilocks principle is also true of opening pressures on a lumbar puncture (LP). This post will discuss what the opening pressure means, and a differential diagnosis for when it is too high or too low and even when it is in the normal range. [+]
Trick of the Trade: Ocular ultrasound for the swollen traumatic eye
You are caring for a patient with an incredibly swollen eye – like a scene out of almost any Rocky film. This patient is likely going to the CT scanner, but regardless of the finding (retrobulbar hematoma, orbital wall fracture, etc.) you still need to evaluate for extraocular muscle entrapment and loss of pupillary response. There’s only one problem: you can’t see the eye. The old standards like getting the patient to retract their lid using paperclips or a cotton swab may help, but sometimes there is just too much swelling, and those techniques are just not enough. Without brute force – [+]
Cardiotoxicity from Loperamide Overdose: The Toxicologist Mindset
The Toxicologist Mindset series features real-life cases from the San Francisco Division of the California Poison Control System. A 21-year-old man with history of opiate abuse was brought in by ambulance after 2 episodes of syncope and 1 episode of self-limited ventricular fibrillation. On initial presentation, the patient was found altered and unresponsive. His mental status improved after the administration of naloxone. On further history, the patient reported ingesting 50 -100 tablets of loperamide (2 mg) daily. A rhythm strip was obtained. [+]
ALiEM Bookclub: Beyond the ED – Recommendations by Dr. Mike Gisondi
“The more that you read, the more things you will know. The more that you learn, the more places you’ll go.” – Dr. Seuss Dr. Mike Gisondi is the program director of the Northwestern Emergency Medicine Residency as well as a leader in medical education, faculty development, and palliative care. He has been recognized both locally and nationally for his work, receiving the 2014 ACEP National Emergency Medicine Faculty Teaching Award as well as being appointed as the director of the Feinberg Academy of Medical Educators (FAME). For readers of ALiEM he is probably best known as the host of the [+]
I am Dr. Megan Fix, Associate Program Director: How I Stay Healthy in EM
Dr. Megan Fix is an emergency physician at the University of Utah. For her, staying healthy is all about maintaining your balance, keeping activating, fostering healthy relationships, and knowing and loving oneself. Despite her busy schedule as the Associate Program Director, she makes a point to still keep family time for her husband and her boys. Her positive attitude about life long learning and going with the flow is something we could all learn from. Here’s how she stays healthy in EM! [+]
IDEA Series: Highlighting FOAM Content through an Asynchronous Course
The Problem Many residents regularly consume FOAM (Free Open Access Medical Education) and online educational materials independently, without faculty guidance or input. At the same time, residency programs are looking for ways to provide high-quality asynchronous learning opportunities to their residents while remaining compliant with the Emergency Medicine Residency Review Committee (RRC-EM) Accreditation Council for Graduate Medical Education (ACGME) guidelines. [+]
A Starter’s Roadmap to EM Resources: Books, Websites, and Apps
With the start of the year, we welcomed a new group of faces into our respective residency programs. We can all still remember how daunting it was to tackle learning the immense volume of material to be a great emergency medicine physician. We have so many amazing resources, but no road maps for where to start. The purpose of this list is to help guide the new interns as well as to highlight some resources that even the more seasoned clinician may find useful. [+]
Using Slack for Residency Communication – Do’s and Dont’s
One of the most difficult parts of residency and medical education is coordination and communication. Often residents and faculty alike can be found drowning in a never ending onslaught of emails, with chains of projects getting buried amongst reply-all’s and attachments. Over the course of the past year, our residency program at Doctors Hospital-OhioHealth in Columbus, Ohio has been using a newer form of communication to facilitate the dissemination of information and collaboration as a group. After some initial exploration into technology and apps, it was decided to try out the program called Slack. Designed to help large groups work [+]
Bark Scorpion Sting: Indications for Anascorp and dosing controversies
The genus Centruroides, also known as the Bark Scorpion, is found throughout the southwestern United States and northern Mexico. Many emergency medicine practitioners in the Southwest are exceptionally familiar with the treatment of envenomation from Centruroides as a quarter million are reported annually1,2. Although typically mild envenomations occur in adults, children and the elderly are at increased risk for severe complications3. The toxic syndrome consists of a sympathetic and parasympathetic storm that can result in myocardial damage, involuntary jerking, wandering eye movements, and most threatening – loss of airway. [+]
Diagnosing the central slip injury
Figure 1. Laceration overlying proximal interphalangeal (PIP) joint of right second digit. (Photograph by Daniel Ting and Jared Baylis) A 34-year-old cabinet maker presents to your Emergency Department after accidentally getting his finger caught in a drawer. On examination, he has a superficial, clean laceration over the dorsal surface of the right second digit (Figure 1). In a previous post, we discussed the approach to identifying, treating, and managing extensor tendon injuries of the hand. In it, we advocate for a high index of suspicion for extensor tendon injuries whenever a patient suffers a laceration to the dorsal aspect [+]