Ondansetron: Has it reduced need for IV rehydration in vomiting kids?
A 3-year-old male presents to the emergency department (ED) complaining of vomiting and diarrhea that has been occurring for 2 days. The mother states that the child has had fewer wet diapers today but has made tears when crying. On physical examination you note no rebound or guarding of the abdomen and determine that the child is moderately dehydrated. Your initial plan is to administer ondansetron and rehydrate the child orally. This is what you have been taught but is it actually efficacious? A just published 2014 JAMA Pediatrics article attempted to answer this question. [+]
Piperacillin/Tazobactam and Risk of Acute Kidney Injury with Vancomycin
There are a few reasons why piperacillin/tazobactam (Zosyn) is not usually my first choice for a broad-spectrum gram-negative agent in the ED. First, at my institution, the Pseudomonas aeruginosa susceptibilities to pip-tazo are lower than that for cefepime. Second, pip-tazo does not have great CNS penetration, especially compared to ceftriaxone, cefepime, or even meropenem. Third, do we really need the anaerobic coverage that pip-tazo provides for every sick patient? Pip-tazo is great for empiric treatment of intra-abdominal and severe diabetic foot infections, but may not be needed for a hospital-acquired pneumonia. Fourth, with its frequent dosing (every 6 hours), too often the second dose is missed if the [+]
Getting Semmelweised: An Essay on Fear and Medical Innovation
The man who saved more lives than any other physician (in the history of humanity combined) died in a mental institution—unrecognized and shunned by the medical community. He was beaten by guards and died a miserable death. Dr. Ignaz Semmelweis was a Hungarian obstetrician practicing in the mid-1800’s, years before Louis Pasteur came up with his germ theory and Joseph Lister popularized hand washing. [+]
Improving debriefing skills: Two-column case and learning pathways grid
Being a learner in a medical simulation case can be tough. But equally challenging, is the role of the Debriefer. This person has to balance the important task of debriefing the small group, provide feedback, and still maintain a positive and open learning environment. A 2013 paper by Rudolph et al attempts to show methods how to balance these demands while improving as a Debriefer through the use of 2 Column Case Analysis and Learning Pathway Grid. [+]
ALiEM Bookclub: How We Die
DNR/DNI, Code Blue, Cardiac Arrest, Traumatic Brain Injury, Exsanguination, Septic Shock, Respiratory Arrest… and the list goes on. As healthcare providers, we are well versed in the medical and emergency resuscitations that can spiral into these dangerous arenas. Even if we don’t always know the exact cause, we know the mantra of ABCs and we stick to it until the end. The very last end… But the end of what? Where is the dignity in resuscitating a body that has already died? Ultimately the question becomes, are we as practitioners as well versed in letting go, in letting the body [+]
Slide Redesign Competition Winners: International Teaching Course 2014
The International Teaching Course, now held twice annually in Baltimore, has a recurring Slide Redesign workshop and competition. Taught by Dr. Stacey Poznanski, this workshop addressed many of the widespread pitfalls which cause “death by powerpoint”. Here are the winners from the workshop competition, illustrating great examples based on Mayer’s multimedia learning theories. The examples below show the before and after slides. Congratulations to the winner, Badria Alhatali, and the close co-runners up, Nadia Awad and Kris Maday! [+]
New Antibiotic Dalbavancin: Should we use this in the ED?
A new antibiotic will soon be approved for skin and soft tissue infections (SSTIs): dalbavancin. The company behind the drug will likely begin marketing heavily to emergency physicians as many patients with SSTIs seek care in the Emergency Department (ED). However, should we seriously consider dalbavancin as an addition to an ED’s arsenal against SSTIs and should it change our practice? [+]
Clinician Educator: The agent for change in medical education
Some people consider teaching and learning much more difficult than rocket science. 1 Teaching and learning is such a complex process that researchers are still having debates in different areas including: how it works, how to assess it, and how to research it. For the most part it is safe to presume that different people have different learning philosophies and this is, most likely, how they teach. 2 Because we are a product of our past and form strong habits, these might inadvertently impede the search of more effective and efficient educational activities. Research in education, just like research medical practice, may challenge our most held [+]
Multiple Mini Interviews (MMI): Annals of EM Resident Perspective article
We are very excited this month to bring you our first ALiEM-Annals Resident’s Perspective discussion. Similar to the ALiEM-Annals Global EM Journal Club series, we will be discussing the most recent Resident’s Perspective piece on the role of Multiple Mini Interviews (MMI) in the EM residency selection process. We hope you will participate in an online discussion based on the paper summary and questions below from now through May 11, 2014. Respond by commenting below or tweeting (#ALiEMRP). [+]
Announcing the ALiEM-CORD Social Media and Digital Scholarship Fellowship
We very are excited to announce an innovative, joint initiative with CORD (Council of EM Residency Directors) in launching the 2014-2015 ALiEM-CORD Social Media and Digital Scholarship Fellowship! The application process for this virtual fellowship is open as of right now to U.S. Emergency Medicine residents. [+]
