Traumatic Brain Injuries in Older Adults
Older adults are at high risk of poor outcomes from even minor head injuries. We see many older patients in the ED who present after a fall or head injury, and we have good decision rules for which patients need brain imaging.1 However, even patients with mild traumatic brain injuries, who have a negative CT scan, are at risk for mortality and significant long-term sequelae. The CDC has called traumatic brain injuries a ‘silent epidemic’.2,3 The first steps to breaking that silence are awareness and recognition. Case A 75 year old male who is not on any anticoagulants presents to [+]
I am Dr. Greg Wanner, Emergency Medicine Resident: How I Stay Healthy in EM
Dr. Wanner (@GregWanner) is an emergency medicine resident from Thomas Jefferson University in Philadelphia. Having been a physician assistant educator in EM for several years prior to his residency, he brings a wealth of experience on how to stay well. Despite this busy schedule, he still finds time to keep fit and spend time with this two daughters. Dr. Wanner is a big supporter of “laughter is the best medicine”. Here’s how he stays healthy in emergency medicine! [+]
Must-Know EM Pharmacotherapy Articles of 2015
There is so much literature to sift through each year, it becomes nearly impossible to stay abreast of it. Here is a quick summary of the 10 must-know Emergency Medicine pharmacotherapy articles from 2015, in my humble opinion. [+]
PV Card: Adult scaphoid fracture
What is the most commonly fractured carpal bone in adults? It's the scaphoid bone. As a bonus it has the dreaded complication of avascular necrosis. So how good are the physical exam and imaging modalities in diagnosing a fracture? What is the likelihood ratio (LR) that snuffbox tenderness predicts a fracture? Bottom lines: The exam is highly sensitive but poorly specific, such that one can only confidently state that a NON-tender snuffbox and scaphoid tubercle essentially rule out an acute scaphoid fracture. Also negative x-rays for patients with scaphoid tenderness still yield a fracture post-test probability of 25%. This PV card breaks down all the LRs.1 PV Card: Scaphoid Fracture Adapted from 1 Reference Carpenter C, [+]
EBSCO Health/DynaMed Plus EM Residency Wellness Grant winner: Dr. Kory Gebhardt
A few months ago, the ALiEM Chief Resident Incubator launched a nation-wide competition to find the best EM residency wellness ideas out there. Today we announce the winner, Dr. Kory Gebhardt and the Northwestern EM residency program. Thanks to the Chief Resident Incubator’s sponsor EBSCO Health/DynaMed Plus for generously underwriting this grant, which focuses on the crucial and often underappreciated aspect of graduate medical education and training — wellness. [+]
Naming contest for ACEP initiative on quality improvement – $250 prize
Are you creative? Got a knack for acronyms and catchy names? Want to have bragging rights on naming a major American College of Emergency Physicians (ACEP) initiative? Want to win a $250 prize? Here is your chance. ALiEM has partnered with ACEP to help be the social media wing in their ambitious, grand-scale quality improvement collaborative based on Choosing Wisely recommendations. [+]
MEdIC Series | The Case of the Awkward Assessors – Expert Review and Curated Commentary
The Case of the Awkward Assessors outlined a scenario where faculty members are put in a difficult position as they try to provide negative feedback to a medical student working in the ED. What did the ALiEM community think of this case? This month the MEdIC team, led by Brent Thoma (@Brent_Thoma) and Teresa Chan (@TChanMD) 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 2 expert opinions. Thank-you to all our participants for contributing to the very rich discussions last week. [+]
AIR-Pro Series: Pediatrics (2016)
Below we have listed our selection of the 14 highest quality blog posts related to 5 advanced level questions on pediatric topics posed, curated, and approved for residency training by the AIR-Pro Series Board. The blogs relate to the following questions: Pediatric arrhythmias Procedural sedation in pediatrics The neonate in distress Toddlers with a limp Pediatric syncope In this module, we have 10 AIR-Pro’s and 4 honorable mentions. To strive for comprehensiveness, we selected from a broad spectrum of blogs identified through FOAMSearch.net. This module we also had two editorial board guests trained in Pediatric Emergency Medicine to increase the strength of our recommendations – Dr. Robert Cloutier and [+]
Trick of the Trade: Extra-oral reduction technique of anterior mandible dislocation
Anterior dislocation of the mandible is a clinical scenario that is not infrequently encountered by the ED provider and requires prompt intervention. The classic technique for reduction of the mandible requires the provider to place his/her thumbs or fingers into the patient’s mouth along the lower molars and apply force inferiorly and posteriorly. However, this technique is fraught with difficulties and inefficiencies including the following: [+]
PEM Pearls: Assessing Radiation Risk in Children Getting CT Imaging – Managing Risk and Making Medical Decisions
The Case: A 5 year old girl presents to the ED with approximately 24 hours of suprapubic and RLQ abdominal pain. Vital signs are: Temp 38.2 C, HR 110, RR 19, BP 100/60, Oxygen Sat 100% on room air. She has vomited twice but has not had diarrhea. She had a history of constipation a year ago that has resolved and mother denies any urinary symptoms or history of UTI’s. The patient is quiet but nontoxic appearing. Your abdominal exam notes mild to moderate RLQ tenderness but no rebound and normal bowel sounds. You order a urinalysis, which is negative and a [+]