Should you do a Pediatric Emergency Medicine fellowship?
Each year hundreds of residents apply to Pediatric Emergency Medicine (PEM) fellowships. There are multiple reasons that an EM resident might want to undertake a PEM fellowship, but over the last 15 years, fewer Emergency Medicine (EM) residents are applying for PEM fellowships than Pediatric residents, unpublished data suggesting that Pediatric candidates now outnumber EM candidates 20 to 1. Recently, a group of PEM Fellowship Program Directors formed the “EM-to-PEM task force” of like-minded individuals desiring to promote PEM fellowships to EM residents. A PEM fellowship is an excellent career move for a resident who has a passion for the [+]
Malignancy-Associated Hypercalcemia: Which Bisphosphonate is Best?
Malignancy-associated hypercalcemia (MAH) is the most common metabolic derangement encountered in the oncologic population in the ED. It can occur in up to 30% of cancer patients at some point during the disease.1–3 Clinical manifestations include mental status changes (which may progress to coma) and renal impairment.3 These patients may be classified based on both type and severity. Therapies for managing MAH emergently should focus on correcting the underlying mechanism, as outlined below with their respective causes:3 [+]
ALiEM Chief Resident Incubator: Mentoring the Future Leaders in EM
We at ALiEM are incredibly excited to publicly announce the 2015-16 ALiEM Chief Resident (CR) Incubator. Every single year, I have seen Chief Residents struggle with their new role as a near-peer leader in the residency program. Because Chief Residents are generally high-functioning individuals, they usually figure it out as the year progresses. Why is it that we can’t we do better and prepare them for what is to come? [+]
Sulfamethoxazole-Trimethoprim for Skin and Soft Tissue Infections: 1 or 2 Tablets BID?
The 2014 Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections (SSTI) recommend sulfamethoxazole-trimethoprim (SMX-TMP) for purulent infections where methicillin-resistant S. aureus (MRSA) is a likely pathogen. 1 But, what dose of SMX-TMP should we be prescribing? Both the SSTI and MRSA guidelines say 1-2 double strength tablets twice a day. 1,2 So, which is it, 1 tablet or 2? [+]
I am Dr. John Bailitz, Director of Ultrasound and Collaborative Research at Cook County: How I Work Smarter
As the “How I Work Smarter” series matures, certain patterns emerge. One clear trend is that ultrasonographers have been present front and center. Today’s installment continue the course with Dr. John Bailitz (@AllInCoachMD) up at bat. Dr. Bailitz is an example to follow for future thinking EM clinician-academicians. While he has mastered the traditional avenues of academics via course leadership, publications, and national presentations, he has also embraced digital scholarship. He is the Chair of ACEP Online Education Subcommittee, blogs at How2TrainHeroes, and is on the organizing committee for SMACC 2015. He generously accepted Chris Nickson’s invitation to share his wisdom [+]
ALiEM Bookclub: The Emperor of all Maladies
The Emperor of All Maladies has become my touchstone for medicine. Siddhartha Mukherjee writes in a poignant and humanist voice as he beautifully captures the “Biography of Cancer.” Interweaving science, stories, and his experiences as an oncology fellow, Mukherjee begins his examination of cancer in the ancient Egyptian times with the story of Imhotep, and carries us through to the modern 21st century diagnosis and management of cancer. From laboratory to bedside, Mukherjee provides both a panoramic and microscopic view of the advances and setbacks of cancer discovery, definition, and understanding. [+]
Ultrasound For The Win: 22M with Scrotal 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 22-year-old man presents with acute scrotal pain. [+]
PV Card: Focused Echocardiography Ultrasound
So many great information can be gleaned from a focused echocardiogram in Emergency Department patients. What views are you obtaining? What is the importance of the e-point septal separation (EPSS) and how to measure this? Drs. Jimmy Fair, Mike Mallon, and Mike Stone provide a terrific step-by-step image-based guide to these questions that you can use at the bedside as a refresher. PV Card: Focused Echocardiography Ultrasound Adapted from [1, 2] References Randazzo M, Snoey E, Levitt M, Binder K. Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med. [+]
Trick of the Trade: L5 medial hamstring reflex
Traditionally in medical school, it is taught that lower extremity deep tendon reflexes for L4 and S1 nerve root levels can be elicited by tapping on the patella and Achilles tendons. It was just taught that L5 didn’t have a reflex to check. Knowing if an L5 radiculopathy existed would be especially helpful when assessing a patient for a potential lumbar disc herniation where a careful lower extremity neurologic exam is important. It turns out one can actually check for a L5 reflex. [+]
I am Dr. Christopher Doty, Program Director and World Class Educator: How I Work Smarter
Dr. Christopher Doty (@PoppasPearls) is a dedicated educator who has helped train countless emergency physicians across two different top academic hospitals, SUNY-Downstate and currently the University of Kentucky. His efforts have earned him the Abraham Flexner Master Educator Award and the position of Vice Chair for Education at the University of Kentucky Department of Emergency Medicine. Oh, and also he can dance! In this How I Work Smarter series, Dr. Doty graciously accepted the nomination by Dr. Mike Stone to share how his approach to life management. [+]