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. [+]
Sepsis in Older Adults: The Presentation May Be Subtle
60% of patients in the United States who develop severe sepsis are older adults (age 65 and over) [1], and the mortality of severe sepsis increases steadily with age to nearly 40% in those over 85 [2]. There are many factors that make older adults more susceptible to sepsis, and that can also make sepsis more difficult to detect. Here are some tips to help explain why this is, and how you can identify it sooner. [+]
PV Card: Focused Lung Ultrasound
Bedside pulmonary ultrasonography is becoming increasingly popular in the Emergency Department. You can you use it to assess for pneumothoraces, pleural effusion, pneumonia, pulmonary edema, and other etiologies. There are subtle nuances to help you differentiate these diagnoses. What are A-lines and B-lines? This PV card on the focused lung ultrasound by Drs. Anne Aspler, Clare Heslop, and Mike Stone outline some great bedside tips. PV Card: Focused Lung Ultrasound Adapted from [1–3] References Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005;12(9):844-849. [PubMed] Liteplo A, Marill [+]
PV Card: Pericarditis – Diagnosis and Treatment Recommendations
When the topic of pericarditis is mentioned, the classic electrocardiogram (ECG) findings of diffuse ST elevation and PR depression are often the focus of discussion. What about the criteria for diagnosis, the 3-prong approach to treatment, and contraindications to colchicine? These are the great questions answered by Dr. Chris Bond (@socmobem) in this PV card, which summarize 3 key papers by Imazio et al from the New England Journal of Medicine, Archives of Internal Medicine, and Circulation. PV Card: Pericarditis - Diagnosis and Treatment Read more ALiEM (PV) Cards.