Assessing and Managing Delirium in Older Adults
Every day in the Emergency Department we see older adults with dementia who have developed delirium and are brought in because of worsening agitation, combativeness, or confusion. In order to care for them, we have to consider what the underlying cause of their agitation may be, but we also have to protect the patient and staff in case of violent outbursts. Older adults experience a phenomenon termed ‘homeostenosis’ in which their physiologic reserve and the degree to which they can compensate for stressors is narrowed, putting them at risk for delirium. This post will outline [+]
Poll : How do you use the PV cards?
In our effort to take the Paucis verbis (PV) card series to the next level, we are interested in knowing how YOU use the cards. We would appreciate your answers to the following 4 questions. Also if you have any comments/suggestions regarding the PV cards and how we can make them better please, use the Comments section. [+]
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EMS Fellowship: 10 Questions I Wish Applicants Would Ask the Fellowship Director
Well, it is EMS fellowship interview season again, and every year after the lovely encounter with very well qualified candidates, I am left wondering if they have achieved a good return on their investment of time and money coming to visit us. Did they really get a good idea of the important aspects of our program, or will they just have to make an educated guess about whether they would be happy spending a year or more with us? [+]
Considering a Medical Toxicology Fellowship?
Every year, EM residents ponder whether to do a fellowship. In the ALiEM Chief Resident Incubator, a handful are very interested in a medical toxicology fellowship, but I woefully am unqualified to provide any advice. So in a “phone a friend” moment, I boldly sent out an email requesting advice and insights. I received two amazing replies from Dr. Lewis Nelson (NYU) from a fellowship director’s perspective and Dr. Annie Arens (UCSF) from a fellow’s perspective. [+]
Top 15 Tips for New EM Residency Graduates: The Real World
Although there is much advice on helping new interns adjust to residency life (part 1, part 2), not much is shared about helping recent residency graduates survive the real world of EM practice. Dr. Amal Mattu, Professor and Vice Chair at the University of Maryland’s Department of Emergency Medicine, solicited for advice from his department’s faculty and recent residency graduates. Below are the top 15 themes which arose from the discussion and are frankly great reminders for all practitioners in the ED. [+]
Trick of the Trade: Squeeze test for confirmation of IO placement
Venipuncture is the most common invasive procedure performed in the emergency department 1 , likely due to the fact that the vast majority of our laboratory evaluations require blood and many of our life saving interventions require access to the patient’s systemic circulation. Most of the time emergency department staff are able to perform this procedure easily, but occasionally you find that your patient is the dreaded “difficult stick”. Literature suggests that the landmark technique is successful on the initial venipuncture 74-77% of the time. 2–5 Success rates rise after multiple attempts, but what happens when you don’t have the luxury [+]
Diagnose on Sight: Traumatic Vision Loss
Case: A 60 year old male presents after being hit by an automobile while riding his bicycle. He has significant blunt head trauma. His left eye is pictured here. What is the diagnosis? [+]
Director of [+]
I am Dr. Erica Dance, Assistant Dean of Resident & Fellow Affairs at University of Alberta: How I Stay Healthy in EM
This week, we have Dr. Erica Dance (@erdance), a wellness guru from the University of Alberta. Dr. Dance is a passionate individual, who loves discussing the topic of wellness. In her role as Assistant Dean she works in the Learner Advocacy and Wellness office to support the well-being of residents and fellows across her institution. Within the post, she shares her tips for how to make wellness part of your everyday routine. Check out how Dr. Dance stays healthy in EM! [+]
Trick of the Trade: Lactated Ringers for Sepsis Complicated by Hyponatremia
An 82-year-old female is brought into the Emergency Department by family for a several day history of progressive altered mental status. You initiate a broad workup. However, soon after initial evaluation, you are called back into the room. The patient’s vitals are as follows and concerning for septic shock and an alarming serum sodium level. [+]
Ultrasound For the Win! Case: 38-year-old pregnant woman with acute right-sided abdominal pain #US4TW
Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this peer-reviewed case series, we focus on real clinical cases where bedside ultrasound changed management or aided in diagnoses. In this case, a 38-year-old pregnant woman presents with acute right-sided abdominal pain radiating to her flank. [+]