High risk back pain: Cauda Equina Syndrome (EREM)
Cauda equina syndrome (CES), which occurs due to compression of the distal lumbar and sacral nerve roots, is a potentially devastating cause of back pain. CES is often missed on the patient’s initial visit which can lead to significant neurologic compromise in a matter of hours [1]. To improve patient outcomes and minimize medicolegal risk, providers need to understand the limitations of the history and physical and carefully consider the diagnosis of CES in any patient with back pain. [+]
MEdIC Series: The Case of the Exasperated Educator – Expert Review and Curated Commentary
The Case of the Exasperated Educator presented an attending at the end of a difficult shift with a learner that just didn’t seem to “get it.” As the new attending coming on shift, how can we help our colleague and his student? How can we avoid getting ourselves into a similar situation? No matter patient we are, odds are that we will all find ourselves in these roles at some point or another. Check out the ALiEM community’s discussion of the case. [+]
Research Figures Demystified: Bland-Altman Plot
While working your shift in a small community ED, you overhear that EMS is on their way to you with a five-year-old child in respiratory distress after eating a peanut butter sandwich. Anticipating the patient to be in anaphylactic shock, you and the senior resident begin planning the course of action. The resident asks, “how much do you think a five-year-old weighs?” While you begin fumbling for your Broselow tape, a nurse seated near you confidently responds, “That’s easy, just count your fingers! One, three, five. Ten, fifteen, twenty! The child weighs approximately twenty kilograms!”. [+]
Atrial Fibrillation Rate Control in the ED: Calcium Channel Blockers or Beta Blockers?
Rate control with IV medications is recommended for atrial fibrillation in the acute setting in patients without preexcitation. This was a Class 1 recommendation (Level of Evidence B) per the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation [1]. What does the evidence say? Are calcium channel blockers or beta blockers better? [+]
Simulation Trick of the Trade: Bleeding Cricothyroidotomy Model
One advantage of simulation as an educational tool is the re-creation of cognitive and emotional stresses in caring for patients. Doing this for a high fidelity scenario is relatively easy – add additional patients, make a them loud, combative, or otherwise cantankerous, and add interruptions for good measure. However, when training for procedures in the simulation lab, we practice the procedure in isolation on a “task trainer” without cognitive and emotional stress for context. An off-the-shelf task trainer can do a superb job of teaching the mechanics of performing a procedure, but they lack complexity necessary to train for performing the procedure under stress. [+]
Transitions of Care: Top 10 things admitting providers wish we did for older adults
“Transitions of care” has become a hot topic in the care of older adults. It is usually applied to the transition from the hospital to home or the hospital to a nursing facility. But what about the transition from the ED to an inpatient service? It turns out there are plenty of things we could be doing (or not doing) to help smooth that transition and improve patient care. Here are some thoughts from admitting physicians with geriatrics training. [+]
Critical Thinking: Minimizing NOT knowing what you do not know
Socratic questioning, a dialectic approach to acquiring knowledge, has been around for ages. If done appropriately, it’s a rigorous method of learning. Questioning reveals our knowledge base, reasoning, and want for clarification; invites a dialogue; and establishes a relationship with others. Socratic questioning can also aid in the development of critical thinking. [+]
MEdIC Series: The Case of the Exasperated Educator
Image credit: wstera Teaching in the emergency department can be a challenge. Distractions and interruptions are everywhere and there always seem to be more things to do than there are people to do them. These challenges are magnified when our learners are struggling. In The Case of the Exasperated Educator, we will discuss these issues and how we, as educators in emergency medicine, can address them as effectively as possible. [+]
Trick of the Trade: Nail Bed Repair With Tissue Adhesive Glue
Patients with fingertip injuries involving the nail bed typically present to the emergency department and require meticulous repair of the nail bed to prevent long-term cosmetic and functional disability. There are several methods to repair nail beds, typically involving absorbable suture, but maybe there is a faster way with similar cosmetic and functional outcomes. [+]
Assessment in medical education: Finding the signal in the noise
This past December it was reported in the Harvard Crimson that the median grade at their prestigious University was an A-.1 A flood of articles followed bemoaning grade inflation at educational institutions with a former Harvard President noting cheekily that “the most unique honor you could graduate with was none”.2 This might be alright if well-developed criterion-based instruments are used to grade the students, but given the variability in courses taught at the University and difficulty of developing such tools, it is unlikely. That being the case, if the median is an A-, one wonders how sub-par performance must be [+]