Must We Avoid Nitrofurantoin with Impaired Renal Function?
Acute uncomplicated cystitis is becoming more difficult to treat in the setting of increasing antimicrobial resistance. In the 2010 IDSA Guideline, as summarized in a PV Card on Cystitis and Pyelonephritis in Women, nitrofurantoin is now listed as the first-line choice, surpassing ciprofloxacin and sulfamethoxazole/trimethoprim from the previous iteration. [+]
RUSH protocol: Rapid Ultrasound for Shock and Hypotension
Patients with hypotension or shock have high mortality rates, and traditional physical exam techniques can be misleading. Diagnosis and initial care must be accurate and prompt to optimize patient care. Ultrasound is ideal for the evaluation of critically ill patients in shock, and ACEP guidelines now delineate a new category of ultrasound (US)– “resuscitative.” Bedside US allows for direct visualization of pathology and differentiation of shock states. The RUSH Protocol was first introduced in 2006 by Weingart SD et al, and later published in 2009. It was designed to be a rapid and easy to perform US protocol (<2 minutes) [+]
PV card: Pediatric Assessment Triangle
Have you heard of the Pediatric Assessment Triangle? Taught in the Pediatric Education for Prehospital Professionals (PEPP) certification course, it provides a clear and simple approach to the emergency assessment of pediatric patients. The following PV card summarizes the PAT: PV Card: Pediatric Assessment Triangle Adapted from [1] Go to ALiEM (PV) Cards for more resources. Reference Dieckmann R, Brownstein D, Gausche-Hill M. The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatr Emerg Care. 2010;26(4):312-315. [PubMed]
Out-of-Hospital Cardiac Arrest and Prehospital Intubation
Worldwide, death from cardiac arrest in the out-of-hospital setting remains the leading cause of mortality. Focuses have aimed at improving bystander CPR, public access to AEDs, minimizing chest compression interruptions, and decreasing the emphasis on advanced airway management. This latter concept has become so important that the AHA/ASA have now changed their “ABC” philosophy to “CAB.” Below is the review of the literature that has changed this philosophy. [+]
Welcome new blog team member: Dr. Matt Astin
Welcome superstar Dr. Matt Astin to the ALiEM blog family. Matt is the Clinical Assistant Professor of EM and IM at Medical Center of Central Georgia, Mercer University School of Medicine. We’re incredibly happy here to add him as our new secret weapon in the social media and FOAM arena. After having met him in real-life at this past SAEM meeting, I can’t imagine a better fit for this team. Welcome! Follow him on Twitter: @mastinmd. Here is brief bio by Matt: [+]
EM-IM Residency Training: Is 5 Years Worth It?
As a new member of the ALiEM team, I am joining Dr. Salim Rezaie as the second member to be board certified in both Emergency Medicine and Internal Medicine. Since 2006, I have been asked numerous times, “Why EM/IM?” My answer is simple: I like both. But five years of residency and not be a surgeon? What can you do with this type of training? [+]
Why do we lecture?
The video lecture below is from Rhona Sharpe (@rjsharpe), the Head of the Oxford Center and Learning Development and Deputy Director of the Directorate of Human Resources at Oxford Brooks University. It is taken from First Step into Learning and Teaching in Higher Education (#fslt12) — a MOOC which took place last year. [+]
Patwari Academy video: Child abuse injury patterns
What are common injury patterns seen in children who are abused? Non-accidental trauma should always be considered in pediatric patients who present with traumatic injuries. Watch this great 8 minute video on child abuse injury patterns by Dr. Rahul Patwari. [+]
On the Horizon: Propofol for Migraines
Propofol for the treatment of migraines in the ED might be on the horizon. This will possibly be a new practice in emergency medicine, although it has been known for some time. Propofol, when given at procedural sedation doses, seems to miraculously terminate migraines refractory to usual treatment. Patients awake with minimal to no headache and may be discharged from the ED much quicker than traditional treatment with possibly less side effects. The proposed mechanism of action is described in below papers, but in short, propofol seems to “reboot” the brain and terminate the migraine. [+]
Maximizing Conferences through Twitter
Conferences are necessary. It’s how we network, exchange research ideas, and share advances in emergency medicine. The reality is that we cannot attend every conference out there because of time, money, and schedule conflicts. But thanks to Twitter, it is no longer necessary to be physically present to reap the benefits of a conference. This post lists information on how to get involved and stay involved with the Twitter conversation and learn from our great conferences without breaking your bank or schedule. [+]