I am Dr. Carl Alsup, Ultrasound Fellow: How I Stay Healthy in EM
Dr. Carl Alsup is an emergency physician and ultrasound fellow at Thomas Jefferson University. His loves for the outdoors keeps him active and fit. Despite being busy with academic commitments, Dr. Alsup maximizes his wellness by incorporating it into his daily routine. His attitude and strategies on maintaining mental wellness are refreshing, and are definitely worth checking out. Here is how he stays healthy in EM! [+]
Trick of the Trade: Ear Irrigation in the Emergency Department
Ear irrigation is an important tool for adult and pediatric patients in the Emergency Department (ED) with ENT complaints. Irrigation can be used to clear ear cerumen, visualize tough-to-see tympanic membranes, and remove foreign bodies. This may reduce the need for subspecialist care and improve the patient’s hearing and quality of life.1 Commercial electronic and mechanical devices are available for irrigation and have been studied. Moulton and Jones presented the improved efficacy of foreign body removal using an electric ear syringe in an (ED) population.2 In this trick of the trade, we present a low cost and effective way of “ear-rigation” [+]
Diagnose on Sight: Case of a red, swollen neck
Case: A 78 year-old female with a past medical history of asthma and hypothyroidism presents with a three day history of sore throat and a two day history of a “lump” along the right side of her neck. The “lump” has now progressed to involve both sides of her anterior neck and is accompanied with erythema, tenderness to palpation, and swelling. In addition, the patient has developed a hoarse voice and odynophagia. The patient’s primary care physician referred her to an ENT specialist, who then referred the patient to the ED for urgent imaging due to the concern for a deep space [+]
PV Card: Introduction to ED Charting and Coding
Editor’s Note (Jan 13, 2023): The new AMA CPT 2023 Documentation Guidelines have completely revamped how the billing and coding for Emergency Department charts is done. See the ACEP FAQ page on the 2023 Emergency Department Evaluation and Management (E/M) Guidelines. What makes a good chart? How do you write a good chart quickly? How about a good, efficient, billable chart? On average, residents and practicing physicians report they did not receive adequate training in charting and coding [1–3] and resident charts are more often down-coded due to documentation failures than those of attendings and PAs [4]. Thankfully, resident [+]
ALiEM Book Club: A Thousand Naked Strangers: A Paramedic’s Wild Ride to the Edge and Back
“EMS is wild and imperfect. Just like our patients. It’s dangerous and a little mad and possibly contagious…patients don’t come to us… we go to them, and where and how we find them, well, that, too, is part of the story. once in the field, we should expect no help.” – Kevin Hazzard [+]
Tanner Gronowski, DO
8 Tips on How to Succeed in Your EM Sub-Internship
This time of year is almost universally overwhelming for visiting medical students at away rotations. They are thrown into a new environment for a brief amount of time and there is a great deal of pressure to impress both faculty and residents. After years of hard work and study, these few weeks may be one of the most influential aspects of a residency application. A survey study of Emergency Medicine (EM) residency program directors by Crane et al. showed that EM rotation grade was the single most important factor in resident selection.1 Given the importance of performing well on this rotation, [+]
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 [+]