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. [+]
HOT OFF THE ALiEM PRESS | ALiEM MEdIC Series, Volume 2
The ALiEM Medical Education in Cases (MEdIC) Series has been a regular feature of our website for almost 3 years. It has been previously featured as a Top 5 What Works abstract at the International Conference on Residency Education in 2014. At the time of our ICRE presentation, we presented our free e-book of our first years’ cases. Now, it’s time for our second edition. [+]
Synthetic cannabinoid use reaches new heights: K2 is not just a mountain on the China-Pakistan boarder
You are working a shift in the emergency department, and you hear the ambulance sirens. EMS is bringing you two patients, friends from a nearby shelter. Per report, the two men were “smoking drugs” together outside of the shelter. Bystanders noted that the 29-year-old man became increasingly agitated, shouting, banging on the door, and threatening his other shelter mates, while the other, a 50-year-old man, laid down on the sidewalk. EMS also reports picking up these patients in an area known for high “K2” use. [+]
Did the Affordable Care Act actually reduce ED visits as politicians promised?
The Affordable Care Act (ACA) was supposed to expand coverage to the uninsured and many politicians claimed this would result in lower use of “expensive emergency rooms” for the treatment of patients’ acute complaints. Ignore, for the moment, the controversy about whether or not the emergency department (ED) is an expensive or appropriate place for patients to seek care. A new survey [PDF] from the Center for Disease Control and Prevention (CDC), asked the question: Did the ACA actually reduce ED visits as politicians promised?1 [+]
Top 10 Educational Initiatives from the Chief Resident Incubator
Chief Resident Incubator, known colloquially as the CRincubator, which for the first time brought together in one virtual space chief residents from EM programs coast to coast. The inaugural class used this opportunity to meet with mentors in EM, discuss difficult situations of being chief residents, and collaborate on projects in areas of education, wellness/public health, leadership and administration. As the academic year comes to an end we want to highlight the top 10 projects that were accomplished by chiefs involved in the CRincubator. [+]
I am Dr. Masashi Rotte, Emergency Physician and Assistant Professor: How I Stay Healthy in EM
Dr. Rotte is an emergency physician currently practicing in New York. His passion for traveling, love of hiking, and commitment to eating right are some of his secrets on how he maintains wellness. Dr. Rotte shares how he is able to get away, travel, and stay well, while keeping up with his work demands. We could all use a little of Dr. Rotte’s passion for life long learning! Here is how he stays healthy in EM! [+]
MEdIC Series: The Case of the Fibbing First Year
Welcome to season 3, episode 7 of the ALiEM Medical Education in Cases (MEdIC) series! Our team (Brent Thoma, Sarah Luckett-Gatopoulos, Tamara McColl, Eve Purdy, John Eicken, and Teresa Chan) is pleased to welcome you to our online community of practice where we discuss difficult medical education cases each month. As usual, the community discussion will be reviewed using qualitative research methods to produce a curated summary that will be combined with two expert responses to create a functional teaching resource. This month’s case dives into the truth omitting or fibbing resident. Why do some learners lie and how should staff respond? [+]