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 [+]
ALiEM Bookclub: Beyond the ED – Recommendations by Dr. Felix Ankel
Most people bring value to a community through their work and their ideas. It is the rare person who brings value by giving us a new perspective. This post is from such a person. Dr. Felix Ankel is Vice President, Health Professions Education at HealthPartners Institute and Assistant Dean at University of Minnesota Medical School. He has been a leader within the EM Education community through his national involvement and leadership in FOAMed. More than his accomplishments, he is best known for contributing to the EM education community as the resident philosopher and for his ability to bring a different perspective to any conversation. Hopefully [+]
MEdIC Series | The Case of the Awkward Assessors
Welcome to season 3, episode 4 of the ALiEM Medical Education in Cases (MEdIC) series! Our team (Brent Thoma, Sarah Luckett-Gatopoulos, Tamara McColl, Eve Purdy, 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 features a couple of colleagues who are trying how to evaluate a medical student appropriate. How can we give critical feedback in a busy emergency [+]
ALiEM Bookclub: Beyond the ED – Recommendations by Dr. Jim Adams
“Leaders become great, not because of their power, but because of their ability to empower others.” Dr. Jim Adams is a Professor of Emergency Medicine (EM) and both the Chair of the Department of EM at Northwestern University and Senior Vice President/Chief Medical Officer for Northwestern Memorial Health Care. Although he is internationally recognized for his contributions to areas of ethics and leadership in EM, for myself and many others, he is best known as a mentor and an inspiration. To spend time with him is to walk away ready to take on the world. We appreciate the opportunity to share [+]