ALiEM BookClub | Lean In: Women, Work, and The Will to Lead
“We still have a problem” Sheryl Sandberg alarms us in her influential 2010 TED Talk, Why we have too few women leaders. “Women are not making it to the top of any profession anywhere in the world.” While women are getting more college degrees and graduate degrees, and more women are entering the workforce than ever before, when it comes to leadership positions, women do not come close to matching their male counterparts. “The blunt truth is that men still run the world.” [+]
PEM Pearls: The nonvisualized appendix quandary on ultrasound
A 10-year old girl presents with progressively worsening right lower quadrant pain for the last 2 days. She reports having chills and feeling warm. Her review of systems is negative for nausea, vomiting, diarrhea, or urinary symptoms. Her abdominal exam is unremarkable except for some diffuse, mild tenderness with deep palpation in bilateral lower quadrants. Labs: WBC 9 x 10^9/L. Because of radiation exposure concerns, you order an abdominal ultrasound as the initial imaging modality to evaluate for appendicitis. The radiologist's reading was: "Unable to visualize the appendix." Now, what do you do? Appendicitis background Appendicitis is one of the [+]
Trick-of-the-Trade: IV Compatibility Information at Your Fingertips
We often have less than optimal IV access to administer fluids, blood products, and medications in sick ED patients. If more than one medication needs to be infused in the same line, how do we know if they are compatible? The gold standard for checking IV compatibility is Trissel’s Stability of Compounded Formulations. 1 But a textbook doesn’t help us in critical situations. Is there a better way? [+]
I am Dr. Bory Kea, Assistant Professor and EM Physician: How I Stay Healthy in EM
Dr. Bory Kea is an emergency physician and assistant professor, currently practicing in Portland, Oregon. Dr. Kea’s love for her family and friends, passion for food, and commitment to enhancing medicine are just a few ways that help her maintain a balance. Whether it’s hitting the trail for a run or running after her little ones, she is constantly trying to stay active. Her ability to appreciate even the small things, is nothing but infectious! Here’s how she stays healthy in EM! [+]
MEdIC Series: The Case of the Fibbing First Year – Expert Review and Curated Commentary
The Case of the Fibbing First Year outlined a scenario where a first year resident fibs about the history he just completed. What did the ALiEM community think of this case? This month the MEdIC team (Brent Thoma, Sarah Luckett-Gatopoulos, Tamara McColl, Eve Purdy, John Eicken, and Teresa Chan), hosted a MEdIC series discussion around this issue with insights from the ALiEM community. We are proud to present to you the Curated Community Commentary and our 3 expert opinions. Thank-you to all our participants for contributing to the very rich discussions last week. [+]
PEM Pearls: Prolonged Fever in Pediatric Patients – When should you worry?
Febrile pediatric patients are ubiquitous in emergency departments (ED) around the country. Parents agonize over the presence, height, and persistence of fever, despite the energy we invest in attempting to reassure them and minimize ‘fever phobia’. But when should we, as providers, also be worried? Very often in pediatric patients we are trying to distinguish self-limited viral infections from potentially harmful bacterial ones. In ill-appearing patients, it’s easy. We treat the patient aggressively as if their symptoms were attributable to a bacterial infection. The proper approach is more opaque with the relatively well-appearing febrile child. How do we pick out [+]
Trick of the Trade: Ultrasound for Pedal Pulse Identification and ABI
The Problem: A patient is rolled in to your ED by EMS with extremity trauma. You’re rightfully concerned about possible vascular injury to an upper or lower extremity, but you can’t palpate a dorsalis pedis (DP) or posterior tibialis (PT) pulse! You spend minutes, whisking the doppler probe, attempting to hear a waveform in a busy ED. Unfortunately you can’t seem to hear the “whoosh,” making accurate it nearly impossible for you to measure ankle-brachial indices (ABI). 1–3 [+]
Trick of the Trade: Securing the intraosseous needle
So much attention is appropriately focused on the anatomy and technique for intraosseous needle placement. In contrast, very little attention is paid to securing the needle. Often this involves a make-shift setup which involves gauze, wraps, and/or tape. This becomes especially important in the prehospital setting where these can be easily dislodged. The following trick stems from a Twitter discussion in 2015 amongst prehospital providers, lamenting this fact. [+]
PEM Pearls: Hydrocortisone stress-dosing in adrenal insufficiency for children
During your shifts in the pediatric ED, you may encounter a few patients with adrenal insufficiency or adrenal crisis. Some of the most common causes include those patients with Addison disease, pituitary hypothalamic pathology, and those patients on chronic steroids. When these patients get sick or sustain trauma, it is important to consider giving them a stress dose of hydrocortisone. Patients in adrenal insufficiency or crisis can present with dehydration, weakness, nausea, vomiting, confusion, lethargy, and severe hypotension refractory to vasopressors. 1–3 [+]
IDEA Series: A Novel Flipped-Classroom Approach to Intern Conference Education featuring EM Fundamentals
The Problem Delivering a curriculum of core content to interns is both a priority and a challenge. Weekly conference provides time to deliver such a curriculum; however, varied rotation schedules limit consistent conference attendance, and intern-targeted content is inappropriate for upper-level residents. We addressed these challenges by implementing a flipped-classroom intern curriculum using training level-specific breakout sessions and a dedicated resource for asynchronous learning. [+]