The 1440 Doctor: Achieving Precision Focus – 3 Ways to Strengthen Your Attention Muscle
If you're like most people, your mind wanders. You may be sitting down to finish your charts, make that presentation (or write that blog) and your mind is off thinking about what you're making for dinner or the fact that you need to call the plumber. Our minds wander and lose focus more often than we think. A study by Harvard psychologists Matthew Killingsworth and Daniel Gilbert showed that our brains spend 46.9% of our waking hours in wandering mode, focusing on something other than the task at hand. That leaves only 53.1% of your attention going to what it’s [+]
Interpretation and Limitations of Opiate Urine Drug Tests
Background Urine drug tests are commonly sent for patients in the emergency department, however care should be taken when interpreting the results of these tests given their limitations. The American College of Medical Toxicology published a position statement on the interpretation of urine opiate and opioid tests [1]. In this publication, they outline many of the limitations of opioid urine drug tests and explain why they exist. Evidence Though often used interchangeably, the terms opiate and opioid are not the same. ‘Opioid’ is the broad category name while ‘opiate’ simply refers to the naturally occurring opioids. The term ‘opioid’ encompasses [+]
IDEA | Airway Series: Reviewing Intubation Footage in Conference to Improve Airway Mastery
Airway management is one of the most critical skills learned by emergency medicine (EM) residents and can be difficult to teach in traditional lectures. Increasingly, video laryngoscopy has been utilized by emergency departments partially due to its increasing first-pass success in certain situations [1]. Additionally from a training perspective, video laryngoscopy has proven to be beneficial as attendings can have the same view as residents and provide real time feedback [2]. However, this valuable real-time feedback and anatomy visualization ability has not always been utilized in other situations such as resident conferences. In this post, we highlight how to [+]
Should Diphenhydramine be included in an Acute Agitation Regimen?
Background Acute agitation in the emergency department is a common issue that frequently requires the use of chemical sedation to preserve safety for patients and healthcare workers. A commonly employed treatment regimen is the combination of haloperidol 5 mg + lorazepam 2 mg + diphenhydramine 50 mg (B-52). Diphenhydramine is included in this treatment regimen primarily to prevent extrapyramidal symptoms [1,2]. However, the incidence of extrapyramidal symptoms (EPS) with haloperidol is quite low when treating agitation in the emergency department (ED) [3,4]. Therefore, the excessive and prolonged sedation from adding prophylactic diphenhydramine may outweigh the intended benefit and should be [+]
PEM POCUS Series: Pediatric Ultrasound-Guided Fascia Iliaca Block
Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric fascia iliac block. 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 Fascia Iliac Block Quiz Module Goals List indications of performing a pediatric point-of-care ultrasound fascia iliaca nerve block (POCUS-FINB) List the limitations of POCUS-FINB Describe the technique for performing POCUS fascia iliaca nerve block Identify anatomical landmarks accurately on POCUS Calculate the maximum safe weight-based local anesthetic dose Recognize the [+]
ACMT Toxicology Visual Pearl: Hypertension and Rash
Which toxic exposure can present with the pictured rash along with hypertension and tachycardia mimicking pheochromocytoma? Arsenic Lead Mercury Silver Thallium [+]
Michael Semple, DO
Washington University School of Medicine
Latest posts by Michael Semple, DO (see all)
Are Thrombolytics Safe for Acute Ischemic Strokes in Patients on DOACs?
Background Direct-acting oral anticoagulants (DOACs), including apixaban, rivaroxaban, edoxaban, and dabigatran, are widely used for various indications and considered first-line therapy for prevention of acute ischemic stroke in patients with nonvalvular atrial fibrillation [1]. The management of acute ischemic stroke in patients on DOACs presents a difficult clinical scenario in the emergency department due to concern for increased risk of hemorrhage. IV thrombolytics (e.g., alteplase, tenecteplase), a mainstay in acute ischemic stroke management, are not recommended in current guidelines for patients whose last DOAC dose was within the last 48 hours [2, 3]. Therefore, patients with an acute ischemic stroke [+]
SplintER Series: Do You Even Lift?
A 35-year-old male presents after injuring his left shoulder while weight lifting two days ago. He describes sudden-onset pain with associated “pop” in his left anterior/medial shoulder and chest as he was bench pressing. On exam, he has ecchymosis over the medial aspect of his humeral shaft and left chest. He has decreased strength with resisted internal rotation of the shoulder. An MRI is obtained and shown above (Image 1: Case courtesy of Dr. Tim Luijkx, Radiopaedia.org, rID: 36975) [+]
Blood Pressure Differences in Patients with Acute Aortic Dissections
Background An acute aortic dissection (AAD) can be a life-threatening emergency which frequently requires rapid and precise control of the patient’s heart rate and blood pressure. The 2010 guidelines for management of patients with thoracic aortic disease suggest a heart rate goal of <60 bpm and a systolic blood pressure between 100-120 mmHg. In order to achieve this, a rapid-acting beta-blocker (i.e., esmolol) may be used in combination with an IV calcium channel blocker (i.e., nicardipine or clevidipine). These medications need to be monitored closely to avoid overshooting these goals and causing hemodynamic compromise. Ideally, an arterial line would be [+]
The Leader’s Library: New Rules of Work | Sign up to join the book club
“...picture a map with point A, which is where you are now, and point Z, which is where you retire after a long career. Twenty years ago, there might have been a reasonably finite number of straight lines connecting those two points. Now it’s like a UV light has been turned on, illuminating dozens of previously hidden interconnected pathways that branch and diverge in many directions. And within this maze are any number of paths that may prove deeply fulfilling for you.” “New normal.” How many times have we heard that phrase over the past year? Thankfully, the first specks [+]