PV Card: Focused Deep Vein Thrombosis (DVT) Ultrasound
Deep vein thrombosis (DVT) is always a consideration when patients with asymmetric lower extremity swelling. Why is one leg. Two-point focused DVT ultrasonography of the femoral and popliteal veins can be incredibly useful in the Emergency Department when trying to narrow the differential diagnosis. Drs. Margaret Greenwood-Ericksen, Joshua Rempell, and Mike Stone provide a clear, image-based clinical reference tool on this ultrasound technique. PV Card: Focused DVT Ultrasound Assessment Adapted from [1, 2] References Kline J, O’Malley P, Tayal V, Snead G, Mitchell A. Emergency clinician-performed compression ultrasonography for deep venous thrombosis of the lower extremity. Ann Emerg Med. 2008;52(4):437-445. [PubMed] Bernardi [+]
Diagnose on Sight: Lower extremity numbness and pain
Case: An 18 year old male presents after a single gunshot wound to his left calf. He complains of pressure-like pain near the wound and sensory numbness below his left knee. On examination, the left leg is tense. He has no dorsalis pedis pulse. Based on the history, exam, and findings in the image, which of the following is true regarding this diagnosis? [+]
I am Dr. Jesse Pines, Professor of Emergency Medicine and Health Policy at George Washington University: How I Work Smarter
This week’s guest on the How I Work Smarter series is a master of efficiency and quality in the Emergency Department. Dr. Jesse Pines (@DrJessePines) is the principal investigator of UrgentMatters.org, a group dedicated to improving emergency care and hospital patient flow. He has the ear of the Center for Medicare and Medicaid Services Innovation Center and the National Quality Forum where, via policy, he’s helping to shape the future landscape of emergency care in the USA. While he has academically published extensively on health policy and workflow, he also takes the time to educate the public at large on the [+]
MEdIC Series |The Case of The Returning Traveller – Expert Review and Curated Commentary
The Case of the Returning traveller generated thoughtful discussion over the past week. We are now proud 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. [+]
Drug interactions with warfarin: Don’t bleed me out!
Warfarin is one of those drugs that always sends off little red warning lights when I see it on a patient’s medication list. Am I going to do something that will make this patient bleed out? Which drugs interact with warfarin? [+]
PV Card: Focused 1st Trimester Pregnancy Transvaginal Ultrasound
Early 1st trimester pregnancies can be challenging to risk stratify when patient present with bleeding or pain. The pregnancy may be still too early for transabdominal ultrasonography, which was covered in last week's PV card. The same authors, Drs. Matt Lipton, Mike Mallon, and Mike Stone provide a great bedside clinical reference tool on performing the focused transvaginal ultrasound in pregnancy. PV: Focused 1st Trimester Pregnancy Transvaginal Ultrasound Adapted from [1, 2] References Tayal V, Cohen H, Norton H. Outcome of patients with an indeterminate emergency department first-trimester pelvic ultrasound to rule out ectopic pregnancy. Acad Emerg Med. [+]
Ultrasound for Verification of Endotracheal Tube Location
In patients undergoing emergent tracheal intubation, there is currently no universally accepted gold-standard test to confirm the location of the endotracheal tube (ETT).1 End-tidal carbon dioxide (CO2) detection is the best of the tests that are routinely utilized to confirm ETT placement, however, it has been shown to have an error rate as high as 1/10 for proper determination of ETT location in emergency intubations.2 As a result, multiple modalities are necessary to confirm ETT location, which can delay mechanical ventilation and other treatments. The lack of a single, reliable test to confirm ETT placement can potentially lead to confusion regarding [+]
I am Dr. Haney Mallemat, ED Intensivist and Lecturer on the Go: How I Travel Smarter
Dear productivity aficionados, today we have a special treat. Dr. Haney Mallemat (@CriticalCareNow) is our guest. However, he has decided to go rogue and approached ‘how to work smarter’ from a very different angle. We are thrilled he did. Dr. Mallemat is a rising star in the world of critical care and emergency medicine. He started off by securing board certifications in Emergency Medicine, Internal Medicine, Critical Care, and Echocardiography. Now, only 5 years out of his Critical Care fellowship, Dr. Mallemat already has a place among the FOAM greats and a position as Assistant Professor at University of Maryland. [+]
MEdIC Series | The Case of the Returning Traveller
Many residents and medical students are engaging in international medical activities. Before departing many do (or should) undergo pre-departure training but how prepared are medical learners to return on the other end? Many struggle with “reverse culture shock”. This month’s ALiEM MEdIC series case considers how we might help a learner returning from an international elective. Please join us in discussing the case this month, we would love your thoughts and advice. [+]
PV Card: Focused 1st Trimester Pregnancy Transabdominal Ultrasound
Although history, physical, and lab tests are obtained for patients with first trimester vaginal bleeding and abdominal pain, none compare to the utility of bedside ultrasonography. Today's PV card reviews the transabdominal approach to the focused pregnancy ultrasound and was written by Drs. Matt Lipton, Mike Mallon, and Mike Stone. PV Card: Focused 1st Trimester Pregnancy Transabdominal Ultrasound Adapted from [1, 2] References Tayal V, Cohen H, Norton H. Outcome of patients with an indeterminate emergency department first-trimester pelvic ultrasound to rule out ectopic pregnancy. Acad Emerg Med. 2004;11(9):912-917. [PubMed] Wang R, Reynolds T, West H, et al. Use of a β-hCG discriminatory zone [+]