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.
I am Dr. Judd Hollander, Master Researcher and Chest Pain Guru: How I Work Smarter
Dr. Judd Hollander is among the most productive members of our speciality. He has over 400 peer review papers and chapters, including some heavy hitters like the recent New England Journal of Medicine CT Coronary Article and an early study of B-Type Natriuretic Peptide for CHF that went on to be cited over 3,000 times. In addition to producing research, he curates it as a deputy editor at the Annals of Emergency Medicine. His academic prowess had lifted him to such positions as President of SAEM and now is the Associate Dean at Sidney Kimmel Medical College of Thomas Jefferson [+]
What is Open Access? Video chat with Dr. Martin Eve
Open Access is not just an issue that plagues scientists and clinical practitioners. Allowing access to scholarly publications and academic work is also widely debated in the humanities as well. We found this out as we sat down and discussed Open Access with Dr. Martin Eve (@martin_eve). [+]
MEdIC Series |The Case of Breaking Bad News Badly – Expert Review and Curated Commentary
The Case of Breaking Bad News Badly precipitated yet another thoughtful and riveting 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. [+]
PV Card: Focused Ocular Ultrasound
Ocular injuries and pathology are a common cause for Emergency Department visits. With bedside ultrasonography, many of these conditions can be assessed. Did you know that you can check for a retinal detachment, vitreous hemorrhage, and even a lens dislocation? What do these look like? Check out this great PV card on the focused ultrasound assessment of the eye. PV Card: Ocular Ultrasound Adapted from [1, 2] Go to ALiEM (PV) Cards for more resources. References Blaivas M, Theodoro D, Sierzenski P. A study of bedside ocular ultrasonography in the emergency department. Acad Emerg Med. 2002;9(8):791-799. [PubMed] Kimberly H, [+]
Diagnose on Sight: Traumatic low back pain
Case: An 18 year old female was the restrained passenger in a motor vehicle crash moving at 65 mph. She complained of traumatic low back pain radiating to her abdomen. What is the most likely mechanism of injury, based on this video of CT images? [+]
I am Dr. Heather Murray, Emergency Physician and Medical Educator: How I Work Smarter
If you’re still trying wrap your mind around the Karpman triangle, the 3 Cs, and Kairos from last week’s post, don’t worry, we have some back to the basics goodness for you. Dr. Heather Murray (@HeatherM211) is an emergency physician primarily but wears many hats: Medical School Leader, Teacher of Evidence-Based Medicine, Journal Editor, Epidemiologist, and Canadian National Board Examiner. I have been told that she is a budding meme expert. But beyond titles, she clearly leaves a lasting impression with her learners. Indeed, fourth year medical student Eve Purdy nominated her to be part of the series. Dr. Murray kindly shared [+]
Anti-NMDA-Receptor Encephalitis
Anti-NMDA-receptor encephalitis is a severe and treatable immune-mediated disorder which presents with a rapid progression of psychiatric and neuropsychiatric symptoms. Although only first reported as a diagnosis in 2007, an exponential number of cases have since been described, suggesting that the disease is not rare but rather under-diagnosed. Emergency physicians play an important role in recognizing this disorder, as prognosis is largely dependent on early treatment with immunotherapy. [+]