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 [+]
Ultrasound For The Win: 46F with Right Abdominal and Flank 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 a real clinical case where bedside ultrasound changed the management or aided in the diagnosis. In this case, a 46-year-old woman presents with acute right-sided abdominal and flank pain. [+]
Trick of the Trade: Needle-vein alignment in ultrasound guided peripheral IV
Placing a peripheral IV under ultrasound guidance is often much more challenging than it outwardly appears, especially for novice users. One of the more difficult aspects is in making sure that the target vessel is perfectly in the middle of the screen and then guessing where that corresponds to the middle of the ultrasound probe. [+]
I am Dr. Deborah Diercks, Professor and Department Chair at UT Southwestern: How I Work Smarter
Over the last 50 years, the rates of women graduating from medical school have increased leaps and bounds, from women representing 7% of US graduates in the 1960s to ~47% in the 2010s.1 The How I Work Smarter Series has had an appreciable yet still unbalanced number of women participants, with slightly more than 35% of posts from women leaders. However, in the top echelon of medicine, women are still dramatically under represented. According to AAMC, only 15% of department chairs are women.2 Dr. Deborah Diercks is one of these 15%. As the newly appointed Chair of UT Southwestern Emergency Department, [+]
ALiEM Bookclub: How to Lie with Statistics
Although the title is ostensibly sinister, Darrell Huff’s “How to Lie with Statistics” is anything but. In medicine, we are faced with complicated statistics and “statisticulators” on a daily basis. And as the field of data science and statistics grows, so too does the complexity of these “statisticulations”. A statisticulation, defined by Huff, is “misinforming people with the use of statistical material” and, unfortunately, this is becoming all too common in the profit-driven world of medicine. With carefully crafted “non-inferiority” trials and overpowered industry-funded superiority trials cropping up in the literature, it would easy to give up on statistics altogether; [+]