SAEM Clinical Images Series: A Backpacker’s Rash
A 33-year-old female presented with a progressively worsening rash for one week. The patient just finished hiking the John Muir Trail, a backpacking trip that encompassed three weeks and over 240 miles. On the last days of the trip, the patient started to develop a severely itchy, red rash on both feet. She tried using a topical anti-fungal, which seemed to make the rash worse. She now has swelling and difficulty walking. The rash does not involve the hands or other parts of the body. She denies fever, open wounds, nausea, vomiting, or systemic symptoms, [+]
Trick of the Trade: Getting the last bit of ultrasound gel from the bottle
It’s a busy shift and you need to perform a bedside ultrasound on a patient’s belly to rule out cholecystitis, when you realize that the ultrasound gel bottle is nearly empty. No matter how many times you vigorously shake the bottle, it’s impossible to get the viscous gel out. In a pinch, you could use hand sanitizer, sterile lubricant, or even water as a substitute for gel. Or you could run to the storage room on the other side of the busy department to grab a new bottle. Or… Trick of the Trade Use centrifugal force to move the [+]
EM Match Advice 38: Our 2 Cents | The Revamped Standardized Letter of Evaluation (SLOE) is here
This is the 38th episode of EM Match Advice but the inaugural episode for new podcast series host, Dr. Sara Krzyzaniak (program director at Stanford EM residency program)! This quick podcast episode was recorded to coincide with the new, much-anticipated release of the Standardized Letter of Evaluation (SLOE 2.0). We address questions of why the changes, and what is different. In this podcast, Dr. Krzyzaniak and Dr. Michelle Lin speak with 2 key faculty who helped lead the multi-year development of this key piece of the residency application puzzle: Dr. Sharon Bord (Johns Hopkins EM Clerkship Director, 2022-23 President of [+]
EM Pharm Pearls: Estimated rise in blood glucose concentration with dextrose administration
A common question is how much should we expect the blood glucose concentration to increase after dextrose 50% (D50) administration. Fortunately, there is an answer from 3 studies. Balentine JR, Gaeta TJ, Kessler D, Bagiella E, Lee T. Effect of 50 milliliters of 50% dextrose in water administration on the blood sugar of euglycemic volunteers. Acad Emerg Med. 1998;5(7):691-694. doi:10.1111/j.1553-2712.1998.tb02487.x PMID 9678393 Population: Healthy volunteers in the ED Intervention: 25 gm (1 ampule of D50) Result: Mean increase of 162 mg/dL at 5 min. Glucose concentrations returned to baseline by 30 minutes. Murthy MS, Duby JJ, Parker PL, Durbin-Johnson BP, [+]
Trick of the Trade: A “Fiberbougie” through a supraglottic airway device (King tube)
Resuscitation before intubation is a critical construct in modern emergency medicine. The prevention of peri-intubation arrest by correcting pre-intubation hypoxia, hypotension, and acidosis is often easier said than done. Worse yet, the intubation process itself, especially if difficult, can worsen hypoxia and hypotension which is often unrecoverable [1, 2] Supraglottic devices, such as a King Airway or laryngeal mask airway, can be placed quickly, and they effectively oxygenate and ventilate patients with a high degree of success [3]. Unfortunately, when the King (or similar device) is exchanged for an endotracheal tube, success is far from guaranteed. Ideally the King could [+]
SplintER Series: Stop! Hammer Time
A 54-year-old female presents to the emergency department with 3rd and 4th right finger pain after “jamming” them a week ago. She was reaching to tap someone on the shoulder and they backed into her hand forcing her fingers into flexion. She has swelling and pain at the distal interphalangeal (DIP) joint of her 3rd and 4th digits on the right and cannot extend the digits at the DIP joint. An x-ray of the right hand was obtained and is shown above (Figure 1: Lateral radiographs of the right hand. Author’s own images). [+]
ALiEM AIR Series | Non-ACS Cardiology 2022 Module
Welcome to the AIR non-ACS cardiology 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 non-ACS cardiology emergencies in the Emergency Department. 12 blog posts met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 5 AIR and 7 Honorable Mentions. We recommend programs give 6 hours (about 30 minutes per article) of III credit for this module. AIR Stamp of Approval and Honorable Mentions In an effort to [+]
ACMT Toxicology Visual Pearl: Pretty (and Deadly) in Purple
What is the correct antidote for a patient who is poisoned with the pictured substance? Digoxin Specific Fab Hydroxocobalamin/Sodium Thiosulfate Physostigmine Pyridoxine (photo used with permission courtesy of Maureen Dallhoff, MD) [+]
Charles Harris III, MD
Carolinas Medical Center
Charlotte, NC
Latest posts [+]
Trick of the Trade: Don’t fight the ultrasound cord for peripheral IV access
Ultrasound-guided IVs require hand-eye coordination and fine movements of probe in Goldilocks fashion. Apply too much pressure, and the vein in question is compressed. Slide a little to the right, and now it's out of the window. Something that practitioners don't think about is the tension from the cord. If left to its own devices, the cord will tug on the probe, making the probe harder to steer and handle, especially for those tiny veins. Trick of the Trade: Reduce cord tension Have the patient grasp the cord! This makes them an active participant. Usually, if they are awake and [+]
PEM POCUS Series: Pediatric Appendicitis
Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric appendicitis. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit. Take the ALiEMU PEM POCUS: Pediatric Appendicitis Quiz Module Goals Describe the indications for performing point-of-care ultrasound (POCUS) for appendicitis Describe the technique for performing POCUS for appendicitis Recognize anatomical landmarks for POCUS for appendicitis Interpret signs of appendicitis on POCUS List the limitations of POCUS for appendicitis Case Introduction: Child with thigh pain Mason is an 8-year-old [+]