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 [+]
Dear emergency physicians: We see you
https://youtu.be/jtGM-BUp_no The COVID-19 pandemic has placed incredible stress and strain on the personal work lives of emergency physicians. We have endured these almost 2 years of misinformation, PPE shortages, fear, frustration, grief, and death. So much going on in the world politically and socioeconomically, we at ALiEM wanted to share a message that WE SEE YOU. We're with you, and we're in this together. Credits Thank you for the tireless work on this video by animator Spencer Evans, who is a soon-to-be-emergency physician attending medical school currently at the University of Colorado. Also thanks to the entire ALiEM team for [+]
SAEM Clinical Image Series: Snowball Effects
A 13-year-old boy presented to the emergency department with complaints of a right eye injury. Five hours prior to arrival, he was struck directly in the right eye with a snowball resulting in immediate eye pain, localized swelling, some flashes of light in his vision and blurry vision. Prior to arrival, the patient had been seen at an optometry center where puff pressures of his eyes were obtained and the right eye was noted to have an increased intraocular pressure (IOP) of 46 mmHg compared to a pressure of 13 mmHg on the left. He continued to endorse photophobia [+]
Education Theory Made Practical (Volumes 4 & 5): An ALiEM Faculty Incubator eBook Series
Back by popular demand and thanks to a generous grant from the Government of Ontario’s eCampus initiative, the ALiEM team is delighted to announce the publication of 2 new eBook publications: Volumes 4 and 5 of the Education Theory Made Practical eBook series [ALiEM Library]. Like all of the others that have come before, these books were a labor of love brought to you by the dedicated Faculty Incubator alumni. On behalf of all the editors of both editions, we are very proud of all our Faculty Incubator alumni who made this happen. Their amazing contributions have been compiled in [+]
SAEM Clinical Image Series: An Uncommon Cause of Shortness of Breath
A 102-year-old female presents with intermittent epigastric abdominal pain for the last two days. Episodes have no relieving or exacerbating factors. The pain originates in the epigastrium and radiates diffusely to the abdomen and back, resolving on its own within minutes of onset. She has had one episode of nonbilious, non-bloody emesis. Her last bowel movement was two days prior and she hasn't been able to pass gas. The pain is associated with mild shortness of breath which has been progressively worsening since the onset of symptoms. Her family was concerned and called EMS because the shortness of breath [+]