The 1440 Doctor: Working From Home (WFH) | 3 Strategies for Being Productive
Physicians have practiced medicine in a variety of practice settings in the past. Some in rural environments, others in austere conditions on a mountain top in Nepal. The recent pandemic has created even a new practice environment in the field of medicine: our own homes. The idea of working from home (WFH) is not a new concept. It’s been gaining momentum for several decades in other fields but healthcare has been slow to embrace this trend. COVID19 changed that. There are many benefits of this new practice environment (basically a 0-minute commute, being able to see family/furry friends during the [+]
EMRad: Can’t Miss Adult Traumatic Hip and Pelvis Injuries
Have you ever been working a shift at 3 AM and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This is a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify injuries that ideally should not be missed. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your [+]
EMRad: Radiologic Approach to the Traumatic Hip/Pelvis
This is EMRad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department [1]. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. Next up: the hip. [+]
David Haase, MD
Department of Emergency Medicine
University of California, Los [+]
SAEM Clinical Image Series: Pulseless and Painful Blue Leg
A 57-year-old male who works as a truck driver with a history of hypertension, type 2 diabetes, and recent COVID-19 infection presents with right lower extremity pain for two hours. He reports experiencing one day of dull aching of the right leg, then being suddenly awakened with the abrupt onset of severe right leg pain and shortness of breath. He denies chest pain. EMS reports a pulseless and painful blue leg en route. The patient denies any history of trauma, irregular heartbeat, or anticoagulation. Vitals: T 97.5°F; BP 120/78; HR 102; RR 20; oxygen [+]
Diagnosis on Sight: “I have a rapid heart rate”
A 31-year-old male presented to the emergency department with palpitations. The patient stated that he thinks his symptoms began "last night" and felt like he had “a rapid heart rate.” He said that prior to last night he felt fine. He did admit to drinking alcohol with his friends 2 nights prior. The patient estimated that he "must have drunk about 30 beers." On review of systems, he reported feeling anxious. He denied illicit drug use, headache, chest pain, cough, shortness of breath, fevers, nausea, vomiting, abdominal pain, dysuria, or increased urinary frequency. He reported that he was unaware of [+]
SAEM Clinical Image Series: A Recurring Neck Mass
A 30-year-old female with no significant past medical history presents to the Emergency Department with a six-day history of an enlarging, tender, red “bump” on her anterior neck. She reports similar swelling during bouts of pharyngitis. She also reports a recent upper respiratory infection one week ago that was marked by fever, cough, congestion, sore throat, and myalgia. She denies shortness of breath, neck trauma, travel, or animal exposures. Vitals: T 37°C; BP 122/78; HR 77; RR 17 General: Well-developed, well-nourished female in no acute distress HEENT: 2cm tender, fluctuant, mobile right anterior neck mass with surrounding [+]
INR reduction with FFP – How low can you go?
Background Bleeding patients or those undergoing procedures that are at high risk of bleeding may require correction of their INR. Multiple products can be used to achieve this, including fresh frozen plasma (FFP). FFP contains many substances, including clotting factors, fibrinogen, plasma proteins, electrolytes, and anticoagulant factors. It is sometimes said that the intrinsic INR of FFP is approximately 1.6-1.7 and that it’s not possible to achieve a lower INR. This pearl will further explore these concerns. Evidence What is the INR of FFP? The mean INR of FFP appears to be ~1.1 (0.9-1.3) [1,2]. Reports that the intrinsic INR [+]
SplintER Series: Pedal to the Metal
A 32-year-old female presents to the emergency department with right ankle pain after a high-speed motor vehicle accident. On exam, she is noted to have ecchymosis and swelling over the distal foot, and pain with ankle dorsiflexion and plantarflexion. An x-ray is obtained as shown above (Image 1. Case courtesy of Dr. Charlie Chia-Tsong Hsu, Radiopaedia.org, rID: 18235). [+]
ALiEM AIR Series | Endocrine 2021 Module
Welcome to the AIR Endocrine 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 endocrine emergencies in the Emergency Department. 7 blog posts met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 4 AIR and 3 Honorable Mentions. We recommend programs give 3.5 hours (about 30 minutes per article) of III credit for this module. AIR Stamp of Approval and Honorable Mentions In an [+]
Unleashing Creativity
Creativity is at the core of process improvement necessary for the advancement of the medical profession. We need to unleash our creativity to meet the rapidly changing needs of graduate medical education. Think of that one person in your department who always seems to be coming up with the newest trick for doing a procedure or a creative method of delivering medical education. What if there was a way for you to become that creative person? The good news is that creative thinking can be learned, and with practice, can become a habit to where it comes naturally. Collect [+]