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. [+]
ALiEMU School Doors Open – Featuring the CAPSULES Series
Our virtual school doors are open starting today to ALiEM University (ALiEMU), which can best be thought of as our open-access, on-demand, online school of e-courses for anyone practicing Emergency Medicine worldwide. This ambitious venture was made possible by a tremendous team, but primarily led by Chris Gaafary, MD (@CGaafary), ALiEMU’s Chief of Design and Development and an EM chief resident in his free time at the University of Tennessee. Today we are incredibly excited to launch our inaugural longitudinal e-course the ALiEM Capsules Series: A Practical Pharmacology for the EM Practitioner, created and led by Bryan Hayes, PharmD, FAACT (@PharmERToxGuy). [+]
ALiEM Bookclub: The New Jim Crow – Mass Incarceration in the Age of Colorblindness
“In the era of colorblindness, it is no longer socially permissible to use race, explicitly, as a justification for discrimination, exclusion, and social contempt. So we don’t. Rather than rely on race, we use our criminal justice system to label people of color ‘criminal’ and then engage in all the practices we supposedly left behind.” (Alexander, 2) The New Jim Crow (@thenewjimcrow) by Michelle Alexander lifts the veil of “color-blindness” to expose the comprehensive, deeply routed, and tacitly disguised racialized criminal justice system that functions very similarly to Jim Crow. The authors calls upon the reader to become informed, and to take action. The foreword [+]
Trick of the Trade: DIY Circulating Water Bath for Frostbite Treatment
A 26-year-old woman presented to an urban Detroit emergency department complaining of bilateral foot pain after walking outside in the snow for 30 minutes without shoes or socks. She was unable to ambulate secondary to the pain and swelling. Physical examination revealed bilateral pallor, doughy texture, and coolness to the touch. There was generalized tenderness to palpation throughout the digits. The overlying skin was edematous, although without signs of breakdown. [+]
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Announcing the 2015-2016 ALiEM-AgileMD Design Fellows!
It is with great pleasure that announce our 2015-2016 ALiEM-AgileMD Design Fellows: Drs. Catherine Patocka and Jeremy Voros. It was a fierce competition with lots of qualified applicants with great ideas and visions, but Catherine and Jeremy stood out. [+]
EREM: Pitfalls and Perils of Emergency Department Discharge Instructions
In the emergency department (ED), failure to comply with discharge instructions has been associated with an increased rate of adverse outcomes for patients. 1,2 There is tremendous variability in the information that is provided to patients in discharge paperwork. In some EDs, a simple handwritten discharge note is given to the patient, while in others, extensive, diagnosis specific pre-created instructions are provided to patients at time of discharge. To improve patient outcomes and reduce their medicolegal risk, providers must recognize pitfalls associated with discharge instructions and include two key elements as a part of all discharge paperwork. [+]
Announcing the 2015-2016 ALiEM Social Media and Digital Fellows!
It is with great pleasure that announce our 2015-2016 ALiEM Fellows for Social Media and Digital Scholarship: Dr. Alissa Mussell from West Virginia University Emergency Medicine Residency Program and Dr. Matthew Klein from Northwestern University Emergency Medicine Residency Program. That’s right, we selected two applicants! The competition was very strong, but we felt that our growth at ALiEM has been so tremendous since we launched in 2009, and most especially in the last year that we could foster the mentoring and development of both of these stellar candidates. [+]
Trick of the Trade: DIY Finger Traps
Distal radius fractures are among the most commonly encountered fractures in the emergency department (ED). They have been reported to account for around 25% of pediatric fractures and up to 18% of fractures in the elderly.1 Reducing minimally displaced distal radius fractures is a procedure that can be greatly facilitated by the presence of finger traps, which help hold traction while you reduce the fracture.2 Often While working in small 5-bed, free-standing emergency department (ED), I found myself needing to perform this vital procedure and finger traps were unavailable. [+]
Blast From the Past: Occult Sepsis, Lactic Acid, and Mortality
Severe sepsis and septic shock affect millions of patients worldwide and have high rates of morbidity and mortality as well as high resource utilization. The way we manage sepsis has changed quite a bit since the Rivers et al randomized controlled trial of early goal-directed therapy (EGDT) 1 , which had an absolute decrease in mortality from 46% with “usual care” to 31% with EGDT. What we now know is that a proactive approach to septic patients will result in lower mortality rates and better outcomes (i.e. early identification, early intravenous fluids, and early antibiotics). Patients with sepsis are still [+]