IDEA Series: Ultrasound-capable, 3D-printed central line trainer
Problem: Central venous line (CVL) placement is a key skill for emergency medicine providers. Sites for central line placement include the internal jugular vein, subclavian vein, and femoral vein. Indications include, but are not limited to fluid resuscitation, medication administration, central venous pressure monitoring, pulmonary artery catheter introduction, and transvenous pacing wire placement. Procedural complications can include catheter-associated infection and arterial puncture. Success rates for CVL placement vary based on location and provider experience [1-3]. Point-of-Care Ultrasound (POCUS) increases both success rate and patient safety when used to guide CVL placement [4]. Figure 1. Setup for ultrasound-capable, 3D-printed [+]
How I Educate Series: John Casey, DO
This week’s How I Educate post features Dr. John Casey, the Program Director at OhioHealth Doctors Hospital in Columbus, OH. Dr. Casey spends 100% of his shifts with learners, including emergency medicine residents, off-service residents, medical students, nursing students, physician assistants/nurse practitioner students, and EMS students. He describes his practice environment as a busy community teaching hospital located on the city's edge, with a diverse patient population and many socioeconomic challenges. Below he shares with us his approach to teaching learners on shift. Name 3 words that describe a teaching shift with you. Use. The. Force. What learning theory [+]
PEM Pearls: An Approach to Infant Apnea
A 2-day-old female born at 41 weeks presents to the Emergency Department (ED) for an episode of apnea. Her parents noticed she stopped breathing, went limp, and turned blue. They are not sure for how long. The infant has had decreased urine output but is otherwise well without any other symptoms. Mom has an unspecified autoimmune condition and is taking hydroxychloroquine. The pregnancy and birth were largely uneventful. Mom was positive for Group B. Strep, had prolonged rupture of membranes, and was appropriately treated with antibiotics. Vitals: The infant’s vital signs in the ED are within normal limits except [+]
How I Educate Series: Alex Koyfman, MD
This week’s How I Educate post features Dr. Alex Koyfman, who serves as core faculty at UT Southwestern in Dallas, TX. Dr. Koyfman spends approximately 90% of his shifts with learners, including emergency medicine residents, off-service residents, medical students, and physician assistants. He works clinically at Parkland Memorial Hospital which is the busiest urban ED in the country. He also spends time in their independent urgent care and ED observation unit, both of which also have a mix of different learners. Below he shares with us his approach to teaching learners on shift. Name 4 words that describe a teaching [+]
SAEM Clinical Images Series: My Eye is Swollen
A 56-year-old male presented to the Emergency Department with a chief complaint of painful eyelid swelling and itching upon waking up. He reported no history of trauma or fever. He had one similar episode in the past which was self-limiting. The patient denied vision loss, diplopia, pain with extraocular movement, and ophthalmoplegia. Vitals: T 37.4°C; BP 129/73; HR 91; RR 16 General: A/O x 3; well nourished in NAD HEENT: Extraocular movements intact in both eyes. Pupils are equal, round, and reactive to light and accommodation bilaterally. Visual Acuity: OD 20/20, [+]
How I Educate Series: Andy Little, DO
This week’s How I Educate post features Dr. Andy Little, the Associate Program Director at AdventHealth Florida in Orlando. Dr. Little spends approximately 90% of his shifts with learners, including emergency medicine residents, off-service residents, and medical students. He describes his practice environment as a busy community EM residency program that sees over 100,000 patients per year. Below he shares with us his approach to teaching learners on shift. Name 3 words that describe a teaching shift with you. Malleable, understanding, fun. What delivery methods do use when teaching on shift? Post its and fill in the blanks. [+]
SAEM Clinical Images Series: Unilateral Facial Pain
A 78-year-old male with a past medical history of Lewy body dementia, hypertension on bisoprolol, hypothyroidism, COPD, chronic lower extremity edema on furosemide, and overactive bladder on oxybutynin presented to the emergency department for evaluation of three days of progressively worsening left-sided neck and facial swelling. Associated symptoms included poor oral intake, a nonproductive cough, and one week of sore throat. The black arrow represents the left parotid gland. Vitals: Afebrile; normal room air saturation HEENT: Firm, tender, warm and erythematous swelling over the left mandibular ramus that extended to the cheek, left neck, and spread [+]
Trick of the Trade: Winging It with External Jugular Cannulation
Sankoff J, et al. WJEM (2008) Imagine yourself caring for a patient that needs urgent vascular access, but several attempts at peripheral intravenous (IV) cannulation have been unsuccessful. You aren’t quite at the point where emergent intraosseous or central venous access is indicated. Maybe those options aren’t even available where you’re working. From across the room, though, you can see a very prominent external jugular (EJ) vein. Sadly, you remember the last EJ line you placed falling out almost immediately. Patients with challenging peripheral intravenous access in the extremities may require and benefit from cannulation of the [+]
How I Educate Series: Geoff Comp, DO
This week’s How I Educate post features Dr. Geoff Comp, the Associate Program Director at Creighton University School of Medicine/Valleywise Health Medical Center in Phoenix, Arizona. Dr. Comp spends all of his shifts with learners, including emergency medicine residents, off-service residents, and medical students. He describes his practice environment as a county hospital with a Level 1 Trauma designation that has both an adult and pediatric emergency room. Below he shares with us his approach to teaching learners on shift. Name 3 words that describe a teaching shift with you. Innovative, evidenced-based, fun What delivery methods do use when [+]
ALiEM AIR Series | Neurology 2022 Module
Welcome to the AIR Neurology Module! After carefully reviewing all relevant posts 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 neurological emergencies in the Emergency Department. 5 blog posts met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 2 AIR and 3 Honorable Mentions. We recommend programs give 3 hours (about 30 minutes per article) of III credit for this module. AIR Stamp of Approval and Honorable Mentions In an effort to truly [+]