How I Work Smarter: Al’ai Alvarez MD
One word that best describes how you work? Compassion Current mobile device iPhone 12 Computer MacBook Pro What is something you are working on now? Where do I begin? The pandemic has opened doors for virtual talks and conferences, so I’m just taking it week by week sometimes. I’m also doing a fellowship, the Stanford Byers Center for Biodesign Faculty Fellowship. I’m learning how to apply design thinking to well-being interventions in the ED, and hopefully collaborating with other high-performance teams. I am also co-directing a conference in May 2022 on High-Performance Resuscitation Teams. How did you come up [+]
The 1440 Doctor: How to Unplug While Working From Home
When we are scheduled for a clinical shift, we are well aware of our work hours for the day (and any added charting time afterwards). However on our academic days working from home (WFH) the separation between work and leisure time becomes more blurry. Harvard Business Review studies found that being on the road can help people switch gears between home and work (1). Blake Ashforth et al. in “All in a Day’s Work: Boundaries and Mirco Role Transitions'' writes about the importance of the transition between work to non-work, including “boundary-crossing activities,” such as putting on work clothes and [+]
Oral Antivirals for Treatment of Mild-Moderate COVID-19 Infection
Background Two new oral agents were given Emergency Use Authorization to be used in patients with mild-moderate COVID-19 at high risk of progression to severe infection, molnupiravir and nirmatrelvir/ritonavir (Paxlovid) [1,2]. Prior to this authorization, most evidence-based COVID therapies were parenteral and required significant healthcare resources to coordinate and administer. Comparison Nirmatrelvir/ritonavir [3] Molnupiravir [4] Mechanism Protease inhibitor leadings to interruption of viral replication Ritonavir has no role in treating COVID-19, it is only included to boost levels of nirmatrelvir via CYP3A4 inhibition Increased frequency of RNA mutations and impaired replication [5] Efficacy vs Placebo (Hospitalization or Death) 0.8% vs [+]
SAEM Clinical Image Series: Painful Blue Arm
A 68-year-old male with a past medical history of hypertension, hyperlipidemia, and recent ileostomy secondary to small bowel obstruction presented for acute left arm swelling, discoloration, and numbness since last night. He endorses sudden onset of painful edema with the development of purple discoloration. He denies trauma, history of similar problems, chest pain, or shortness of breath. He endorses difficulty flexing at the elbow secondary to the amount of swelling, pain, and numbness to the arm. The patient had a peripherally inserted central catheter (PICC) line placed in the left upper extremity two weeks ago. [+]
Balanced Fluids in Diabetic Ketoacidosis
Background Many guidelines and treatment algorithms for diabetic ketoacidosis (DKA) recommend sodium chloride 0.9% as the replacement fluid of choice, though alternative fluids may be a better option [1-4]. Randomized trials, in adult and pediatric patients, demonstrate faster resolution of DKA when using balanced solutions (e.g., PlasmaLyte-A, lactated Ringer's) compared to sodium chloride [5-7]. Dr. Josh Farkas provides further review of this topic in 3 excellent and detailed EMCrit posts [8-10]. Evidence A phase-2 study published in 2021, SCOPE-DKA, randomized 93 patients with severe DKA (median venous pH 7.0) to receive PlasmaLyte-148 (PlasmaLyte-A) or sodium chloride 0.9% [11]. During the first [+]
IDEA Series: Escape the Snake Room
The Problem A snakebite from a venomous snake can result in a potentially life-threatening toxin-mediated disease (1). The WHO considers snakebites to be an important occupational disease in Southeast Asia (2). Particularly in rural areas of Pakistan, snakebites represent a common public health concern. The relatively rare nature of this condition in urban environments, however, limits exposure to it by emergency medicine (EM) residents. Thus, additional focused training is necessary to prepare EM physicians to manage snakebites in a timely and effective manner. The Innovation The “Snake Room” gamification-based, timed activity teaches and assesses clinical practice essentials in the management [+]
SAEM Clinical Image Series: Inguinal Masses
A 50-year-old female with a past medical history of gastritis and marijuana abuse presents to the Emergency Department (ED) with epigastric abdominal pain for one day. The patient reports she was seen in the ED one month prior for similar symptoms and had an ultrasound of the gallbladder, which was negative. She was discharged home with prescriptions for Pepcid, Carafate, and Zofran. Once discharged home she did not experience any symptoms until the day prior to presenting again to the ED. The patient denies nausea, vomiting, back pain, dysuria, hematuria, subjective fevers, chills, diarrhea, vaginal bleeding, vaginal discharge, chest [+]
Apply now for the ALiEM Faculty Incubator 2021-22 Class: Scholarship and Community
Happy new year! Make one of your new year's resolutions to accelerate your scholarly career in health professions education. The ALiEM Faculty Incubator is opening its doors to the sixth class of 30 educator-scholars. We have been thrilled by the quality of collaboration, growth, and scholarship output from this community ever since our first class in 2016. Led by Dr. Sree Natesan as the Chief Operations Officer and Dr. Antonia Quinn, Associate Chief Operations Officer, we are excited to kick off this new year. We feature an all-star leadership team which includes Dr. Sara Krzyzaniak (Chief Academic Officer), Dr. Michael [+]
SAEM Clinical Image Series: I Have a Stomachache
An 18-year-old male with no significant past medical history presents with diffuse abdominal pain and multiple episodes of non-bloody, non-bilious vomiting for three days. The patient was seen yesterday at another facility and states he was diagnosed with gastritis and discharged with Zofran, which provided no relief. He denies fever, diarrhea, or urinary symptoms and states his last bowel movement was two days ago and was consistent with his usual bowel movements. Vitals: T 97.7ºF; HR 138; BP 122/98; RR 18; O2 sat 99% on RA General: Thin male, appears uncomfortable Abdominal: Mild distention [+]
Improving Your ED Efficiency: Upgrade This Elusive Skill
No specialty in medicine requires “efficiency” more than Emergency Medicine (EM). Being able to seamlessly and quickly move between tasks is a necessary skill to function in the Emergency Department (ED). The controlled chaos and many moving parts can be overwhelming to new learners in the department and takes dedicated time and experience to overcome. Along with learning the necessary medical knowledge, efficiency expertise is crucial to becoming a high-performing emergency physician. Unfortunately, there is minimal formal training on how to maximize efficiency skills, leading many new EM learners (e.g. medical students and junior residents) having to troubleshoot and create [+]