Trick of Trade: Removal of Entrapped Metal Zipper
A young boy is brought to the pediatric emergency screaming at the top of his lungs by his parents. His penile skin is trapped in the zipper of his jeans. On a busy shift, you want a simple way to handle zipper injuries that minimizes pain, doesn't require resource-intensive procedural sedation, and is quick. Background The 4 most common types of zippers are nylon coil zip, plastic mold zip, metal zip, and invisible zip. Most of the techniques describing solutions on zipper entrapment in the medical literature are derived from case reports and case series. All revolve around understanding [+]
Trick of Trade: Inflating the Esophageal Balloon of a Blakemore/Minnesota Tube without a Manometer
A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. He looks really bad, stating that he has been vomiting blood. He is hypotensive. He then vomits a copious amount of blood right in front of you. You intubate the patient and initiate the massive transfusion protocol, but everything you pour into him seemingly comes right back out. The gastroenterologist on-call states that he is too unstable for endoscopy. It is time for a balloon tamponade device. You’ve trained for this and set up everything. [+]
EM Match Advice 40: Program Directors Reflect on the 2023 Match
The 2023 Emergency Medicine Match was an unprecedented year that took many of us in the education community by surprise. There were 132 (46%) EM residency programs with at least one unfilled PGY-1 position, and there were 554 (18.4%) overall unfilled EM positions. Dr. Sara Krzyzaniak (EM program director at Stanford) hosts this important episode with Dr. Michelle Lin (ALiEM/UCSF), reflecting on the whys, hows, and what nexts. Fortunately we have experts Dr. Abra Fant (Northwestern PD) and Dr. Richard Church (University of Massachusetts PD) to help us with a deeper dive and forecasting the future. Episode 40: Reflections [+]
SAEM Clinical Images Series: My Eye Looks Different
A 29 year-old-male with a past medical history of left eye enucleation secondary to a gunshot wound several years prior presents to the Emergency Department (ED) for blurry vision, redness, and concern for a deformity to his right eye. The patient states symptoms started 2-3 months ago and he initially thought symptoms were due to allergies and recalls rubbing his eye a lot. Over the past 3-4 days, he noticed an acute decline in his vision with what the patient describes as a “cloudy bump” appearing during that time. The patient normally does not wear [+]
ALiEM AIR Series | Procedures Module
Welcome to the AIR Procedures Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to related to procedures in the Emergency Department. 6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. More specifically, we identified 2 AIR and 4 Honorable Mentions. We recommend programs give 3 hours of III credit for this module. AIR Stamp of Approval [+]
Trick of the Trade: Gel-free ultrasound-guided peripheral IV technique
Ever finally step away from a busy resuscitation and someone stops you for peripheral IV access? You set up everything, have the patient positioned, and then notice there is no sterile ultrasound gel. No gel? No problem. The trick is to eliminate anything of poor acoustic impedance between the ultrasound probe and the patient's skin. Trick of the Trade 1. Apply a transparent adhesive dressing with a thin alcohol layer on the probe Instead of using gel, we squeeze alcohol pads to create a thin alcohol layer and place a transparent adhesive cover, such as Tegaderm ©. The thin [+]
SAEM Clinical Images Series: A Rare Pediatric Scalp Rash
The patient is a 3-month-old, full-term male who presents with a rash on his head. The rash started one day prior to presentation on his forehead and spread to the rest of his head. Today, it developed a central clearing with surrounding redness. He has a history of sensitive skin since birth with patches of eczema and cradle cap. He treats these with Aquaphor and Honest Co. Cream; he has never been prescribed topical steroids for his rashes. Denies fever, cough, rhinorrhea, congestion, decreased appetite, diarrhea, and decreased urination. He had an uncomplicated birth history. [+]
How I Educate Series: Jailyn Avila, MD
This week’s How I Educate post features Dr. Jailyn Avila, core faculty at Southwest Healthcare EM Residency and creator of Core Ultrasound. Dr. Avila spends approximately 70% of her shifts with learners which include emergency medicine residents, off-service residents, and medical students. She describes her practice environment as a hybrid academic/community practice that is about to start its 3rd year of EM residents. Below she shares with us her approach to teaching learners on shift. Name 3 words that describe a teaching shift with you. Focused, contentious, applicable. What delivery methods do use when teaching on shift? Mostly verbal, [+]
Trick of the Trade: Chest tube rewarming with Foley tubing connector
You have a pulseless hypothermic patient requiring aggressive internal rewarming. ECMO is not available, and you’ve made the decision to initiate thoracic lavage. After placing your chest tubes, you step back triumphantly, but in short order, the nurse hands you large diameter IV tubing with warmed fluids so that you can connect it to the chest tube. You are left with the IV tubing in one hand and a chest tube in the other with no time to waste, but no elegant or straightforward solution to interface the two. Trick of the Trade Using Foley bag tubing The [+]
The Febrile Infant: Incorporating the 2021 American Academy of Pediatrics guidelines
Can you trust a febrile infant? “No” has been, and continues to be, the resounding answer over the last 40 years as researchers and clinicians work to determine the optimal evaluation and management of the well-appearing young febrile infant [1]. The goal remains to identify infants with bacterial infections in this at-risk cohort of patients while also considering the balance of cost-effectiveness on a population scale and the potential for iatrogenic harm with evaluation such as unnecessary lumbar punctures, unnecessary antibiotics, and unnecessary hospitalization. Fortunately, bacteremia and bacterial meningitis in this age group are uncommon [2]. Unfortunately, delayed or [+]