Welcome ALiEM Resident Editor Dr. Natalie Desouza
There are many things that print journals do well. One of the best ideas that I have seen from the Annals of Emergency Medicine is the unique idea of having a Resident Editor on the executive team. This provides the resident exposure to the behind-the-scenes operational processes of running a journal under a mentored environment. Similarly, ALiEM has experienced such rapid growth in the past year with the addition of amazing regular bloggers that we are ready to welcome our first Resident Editor Dr. Natalie Desouza (UCSF-SFGH EM senior resident). [+]
Alcohol Problems Among Older Adults in the ED
The complications of alcohol use can be subtle in older adults, and the effects of alcohol are often incorrectly attributed to aging. Because of its under-recognition, the barriers to screening, and the many subtle ways in which it can present, some have suggested that alcohol misuse has replaced syphilis as the “great masquerader”. If you don’t think alcohol misuse is a problem among older adults in your ED, it may be because it has been hidden in plain sight. [+]
Share your tips: Managing digital information overload
In this digital age, it is somewhat assumed that you know how to manage all the digital information coming at you in the forms of email, Facebook, Twitter, blogs, podcasts, RSS feeds. Even if you only partake in email as your primary communication platform, information still can be quite overwhelming as a trainee or practicing medical provider. At a the annual Bay Area EM residency conference last week, Dr. Charlotte Wills (Highland), Dr. Rebecca Smith-Coggins (Stanford) and I were invited by Dr. Esther Chen (UCSF-SFGH) to share some our personal insights and advice on a panel. We quickly realized that [+]
Simulation Trick of the Trade: Blindfold the Leader
Simulations are routine now in medical training. But sometimes routine can start to get boring! All learners now know, especially for high fidelity simulations, to prepare for the unexpected. The stable patient will inevitably crash, maybe when your back is turned; the confederate in the room may or may not be a friend or a foe, you may never know! But these twists have become so integral to the simulation case that most learners know how to deal with it, or at the least know to anticipate it. But here is an idea for adding a new challenge to a stale simulation case. Blindfold the leader! [+]
Open Educational Resources
The Internet has not only facilitated connectivity between people, but it has also helped us to connect with educational material quite different from that of a physical textbook. We are consuming information at a much more rapid rate, and we are also becoming producers of content online. With the use of hyperlinks we are also connecting one content material with another, allowing for a more dynamic-instantaneous flow of knowledge as opposed to the static print in a physical textbook. People have started seeing the potential that this brings to education and are placing educational content online. These educational materials include [+]
MEdIC series: The Case of the Difficult Consult
Inspired by the Harvard Business Review Cases and led by Dr. Teresa Chan (@TChanMD) and Dr. Brent Thoma (@BoringEM), the Medical Education In Cases (MEdIC) series puts difficult medical education cases under a microscope. On the fourth Friday of the month we will pose a challenging hypothetical dilemma, moderate a discussion on potential approaches, and recruit medical education experts to provide “Gold Standard” responses. Cases and responses will be made available for download in pdf format – feel free to use them! If you’re a medical educator with a pedagogical problem, we want to get you a MEdiC. Send us your most difficult dilemmas and help the rest of us to [+]
Bundle Branch Blocks (BBBs) 101
Recently, I have been asked by several students at my home institution (UTHSC at San Antonio) to help them understand bundle branch blocks. This is different than some of my usual posts because it is meant to be more educational than evidence based. So here we go. The normal conduction system of the healthy heart is shown to the right. If there is a delay or block in the left or right bundle, depolarization will take longer to occur. Therefore we get a widened QRS (>0.12 sec or >3 small boxes). [+]
R-Wave Peak Time (RWPT) in Lead II: One Simple Step to Differentiate Wide Complex Tachycardias
There are several algorithms that are currently used to help distinguish Supraventricular Tachycardia (SVT) with aberrancy and Ventricular Tachycardia (VT). Many of these algorithms lack specificity, and let’s face it, who can remember if the absence of an RS complex in the precordial leads is VT or SVT with aberrancy. So what if there was a criterion that had a good sensitivity (SN), specificity (SP), and was one simple step? [+]
PV Card: Brugada Criteria for SVT with Aberrancy vs Ventricular Tachycardia
Due to the overwhelming popularity of Dr. Salim Rezaie's recent post discussing the Brugada criteria for SVT with aberrancy vs VT, Dr. Jason West (@JWestEM, an EM resident from Jacobi/Montefiore) kindly helped to co-author and package this information into a PV card for quick reference. To use this sequential, four-question approach, if at any time you answer YES to the question, it is ventricular tachycardia. PV Card: SVT vs VT - Brugada Criteria Adapted from [1] Go to ALiEM (PV) Cards for more resources. Reference Brugada P, Brugada J, Mont L, Smeets J, Andries E. A new approach to the differential diagnosis [+]
QI Series: Cellulitis vs Necrotizing Fasciitis
Case A 50-year-old male was referred to the ED for evaluation of cellulitis. The patient had developed pain and swelling in his right groin region 5 days earlier. He had seen his physician 3 days before the ED visit and was started on Doxycycline. On the day of evaluation, he had returned to the office with increasing redness so was referred to the ED. [+]