AIR Series: Respiratory Part 1 (2015)
We found an enormous amount of posts on respiratory topics and thus have divided the content into two modules. This first module will focus on general respiratory issues with airway and pulmonary embolism covered in the second module. Below we have listed our selection of the 15 highest quality blog posts within the past 12 months (current as of April 2015) related to respiratory, curated and approved for residency training by the AIR Series Board. In this module we have 4 AIRs and 11 Honorable Mentions. We strive for comprehensiveness by selecting from a broad spectrum of blogs from the top 50 listing per the Social Media Index. [+]
Salicylate Toxicity PV card v2: Lessons in post-publication review
I was recently the author of a PV card for management of Salicylate Toxicity, which had some discrepancy with expert opinion. The point of contention was in regards to measurement of urine pH vs serum pH for alkalinization. In preparing the first version of the card, I began with notes from a recent toxicology rotation, and expanded by examining textbooks and review articles. Although there was mention of serum pH measurement, numerous sources emphasized urine alkalinization as the primary endpoint for the treatment of aspirin toxicity. Therefore I choose to include this on the size-limited PV card. Despite review by numerous peers [+]
I am Dr. Gillian Schmitz, Associate Program Director, UT San Antonio: How I Work Smarter
Today we feature another young star in our field. Dr. Gillian Schmitz (@GillianMD1) is part of the next generation of emergency medicine leaders. In her young career she has already been decorated with several teaching awards, including the Academy for Women in Academic Emergency Medicine Early Career Faculty Award. An active member of EMRA as a resident, she continues her societal involvement as the chair of the ACEP Academic Affairs Committee. In a recent move to UT San Antonio, she helped launch a new residency program and currently serves as the associate program director. Dr. Schmitz kindly shares her pearls [+]
I am Dr. Ryan Tam, Emergency Medicine Resident: How I Stay Healthy in EM
Finishing up his first year as an emergency medicine resident, Dr. Ryan Tam has strived to integrate wellness into his normal routine. Maintaining his love for cooking and photography has helped provide him with balance over the past year. Being a foodie, he’s got great tips to eating well and hitting all of the essential food groups. Believe it or not, the food still tastes great! He hopes that his small changes in day to day routine, will become permanent habits of wellness. Here’s how he stays healthy in EM! [+]
ALiEM Bookclub: How Not to Be Wrong – The Power of Mathematical Thinking
“Math is like an atomic powered prosthesis that you attach to your common sense, vastly multiplying its reach and strength.” – Jordan Ellenberg “If you don’t get elementary probability in your repertoire, you’re like a one-legged man in an ass-kicking contest.” – Charlie Munger When your grade school teachers told you that you’d be doing math every day of your life, you scoffed. In adulthood, you likely took perverse pride in noting their predictions to be wrong. Enter Jordan Ellenberg (@JSEllenberg) to show you that math is nothing less than a method of thinking and reasoning, and it pervades your everyday decisions. [+]
Tricks of the Trade: Fluorescein application techniques for the eye
Application of fluorescein is a vital part of the workup of ocular complaints. Despite some studies showing questionable support, the typical cited clinical concern for stored fluorescein solutions is contimination with Pseudomonas and risk for iatrogenic infection with associated ulcer formation. 1–4 Subsequently, single dose sterile strips have become the standard agent stocked in most EDs. Many patients, especially children, can be apprehensive of the application of the physical strip directly to the eye, and are more comfortable with the concept of eye drops. In this post, we review multiple technique to create fluorescein solutions and additional tips for utilization [+]
Trick of the Trade: Eye pH
Your patient presents with an ocular burn after accidentally splashing an industrial acid on his face. You, however, can not seem to find the ever elusive eye pH paper to track her initial and serial pH’s during copious ocular irrigation. Now what? [+]
Diagnose on Sight: Diffuse Desquamating Dermatitis
Case: An 84 year old female presents with five days of a diffuse rash. She had a seizure and was started on phenytoin 2 weeks ago. Her mouth, labia, and medial canthi are involved. There are scattered areas of desquamation comprising less than a tenth of her total body surface area. She is tachycardic and febrile. Her complete blood count differential is normal. What is the diagnosis? [+]
MEdIC Series | The Case of the Flirtatious Patient – Expert Review and Curated Commentary
The Case of the Flirtatious Patient has been sparse in volume of comments but we’ve still had a really interesting set of comments over the past week. We are now happy to present to you the Curated Community Commentary and our two expert opinions. Thank-you again to all our experts and participants for contributing again this week to the ALiEM MEdIC series. [+]
Methemoglobinemia: Not the Usual Blue Man With Low SpO2
On a Friday night shift, an ambulance brings you a 52 year-old man who had an episode of syncope at a local club. EMS found him confused and hypoxic with poor skin color. The patient was placed on oxygen via face mask en route to your ED without clinical improvement. On exam, you note a blue discoloration of his extremities, and his chest x-ray and ECG are unremarkable. You draw blood, which appears very dark, and an ABG demonstrates pH 7.39, PCO2 41, and PO2 176. Figure 1. Blue foot Figure 2. Dark arterial blood You suspect [+]