Simplified Dosing Scheme for DigiFab® in Acute Digoxin Poisoning

By |Oct 16, 2021|Categories: EM Pharmacy Pearls, Tox & Medications|

Background Treatment of digoxin toxicity can be quite complex and generally involves the use of digoxin immune Fab (DigiFab®) for symptomatic patients. The dosing of DigiFab can vary depending on the amount ingested, serum concentration, and/or suspected chronicity of toxicity. Alternatively, for an acute ingested of an unknown amount where the serum concentration is not available, it is recommended that 10 vials of DigiFab be administered empirically. This antidote is expensive (~$5,000 per vial) and not always readily available in every hospital. Given the complicated dosing and cost, alternative dosing strategies are being explored. Evidence Researchers from Australia first proposed [+]

IDEA Series: DIY Suture Kit Station

By |Oct 15, 2021|Categories: IDEA series, Trauma|Tags: |

In medical training there is a lack of simulation based activities including procedural labs. Suturing is a critical skill for trainees to master in the emergency department. However, supervised practice is needed prior to suturing a real patient for the first time. This innovation allows early trainees to master suturing while on shift, using easy to find materials, which increases procedural competency and confidence. This activity allows the teacher to assess and correct the trainees procedural skills prior to attempting to suture a real patient. Name of innovation This Do-It-Yourself Suture Kit Station incorporates easy to find materials available in [+]

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20 Tips for Career Success and Longevity in Emergency Medicine

By |Oct 13, 2021|Categories: Academic, Life, Wellness|

Photo by Snapwire on The practice of emergency medicine (EM) is consistently challenging. At any given moment during a shift, emergency physicians are responsible for making numerous decisions about multiple patients. Many of these decisions are time-sensitive, some a matter of life or death. Physical, intellectual, and spiritual fatigue can set in during or after a shift. Our consultants, clinic physicians, or hospital administrators rarely understand the roller coaster we ride. Out of necessity, those of us practicing EM look for ways to navigate the peaks and valleys that make up the natural rhythm of the emergency department. I was [+]

  • Sternal injury

SplintER Series: Don’t Go Breaking My Heart

By |Oct 11, 2021|Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|Tags: , , , |

A 45-year-old man presents to the emergency department with chest pain after a high-speed motor vehicle accident where his sternum hit the steering wheel. You notice an area of ecchymosis noted over his sternum, so you decide to get a CT scan (Figure 1). Figure 1. Case courtesy of Dr Henry Knipe,, rID: 26332   [+]

Stanford’s INFODEMIC Conference on COVID-19 Misinformation: Open-access podcasts

By |Oct 8, 2021|Categories: Academic, COVID19|Tags: , |

In July 2021, Dr. Vivek Murthy became the first U.S. Surgeon General to declare health misinformation a public health crisis. Specifically, COVID-19 vaccine misinformation and disinformation on social media greatly affects vaccination rates in certain populations. Rapid increases in reliable health information about COVID-19 can be overshadowed by the spread of even greater amounts of misinformation, leading to an ‘infodemic.’ The World Health Organization defines an infodemic as: “... too much information including false or misleading information in digital and physical environments during a disease outbreak. It causes confusion and risk-taking behaviours that can harm health. It also leads to [+]

SmilER 104: Pericoronitis and Dry Socket

By |Oct 6, 2021|Categories: ALiEMU, Dental, SmilER|

This fourth and final installment in the SmilER series covers the diagnosis and management of 2 common dental conditions that present to the emergency department: pericoronitis and dry socket. Author: Richard Ngo, DMD Editors: Cameron Lee, DMD, MD; Andrew Eyre, MD, MS-HPEd Series Editor: Chris Nash, MD How well did you learn the material? Go to ALiEMU to take the multiple-choice quizzes to receive your badges and certificates. Learning Objectives Understand diagnostic criteria of pericoronitis and alveolar osteitis (dry socket). Understand treatment modalities for patients with pericoronitis and alveolar [+]

SAEM Clinical Image Series: Silver Scales

By |Oct 4, 2021|Categories: Dermatology, Pediatrics, Rheumatology, SAEM Clinical Images|

A 6-year-old otherwise healthy female presented to the emergency department (ED) with a rash across all four extremities. She has had seven months of pruritic, expanding lesions starting on her shins, now beginning to expand on her forearms. No history of allergies or irritant exposure. Due to Covid-19, she has been unable to see a provider before today’s ED visit.     Vitals: T 98.3°F; BP 96/72; HR 92; RR 24; O2 sat 100% Skin: Numerous patchy red lesions scattered across bilateral upper and lower extremities with silver plaque accumulation. No nailbed involvement. No mucous membrane [+]

SmilER 103: Odontogenic Infections

By |Sep 30, 2021|Categories: ALiEMU, Dental, SmilER|

This third module for the SmilER series covers the diagnosis and management of odontogenic infections seen in the emergency department (ED). What anatomical structures should be avoided? When is imaging necessary? What is the discharge plan? Author: Richard Ngo, DMD Editors: Cameron Lee, DMD, MD; Andrew Eyre, MD, MS-HPEd Series Editor: Chris Nash, MD How well did you learn the material? Go to ALiEMU to take the multiple-choice quizzes to receive your badges and certificates. Learning Objectives Understand the major classifications and diagnostic criteria of odontogenic infections. Understand the [+]

ED Management of Cannabinoid Hyperemesis Syndrome: Breaking the Cycle

By |Sep 27, 2021|Categories: Academic, Emergency Medicine, Tox & Medications|

What is cannabinoid hyperemesis syndrome? Cannabinoid hyperemesis syndrome (CHS) is a condition in which patients who have been using cannabis or synthetic cannabinoids for a prolonged period of time develop a pattern of episodic, severe vomiting (usually accompanied by abdominal pain) interspersed with prolonged asymptomatic periods. When should you consider cannabinoid hyperemesis syndrome as a diagnosis? The diagnostic criteria for CHS require evidence of relief of symptoms with sustained cessation from cannabis, which makes them of limited utility in the Emergency Department (ED) [1]. However, a number of ED-based diagnostic criteria have been proposed with overlapping features [1,2]. There are [+]

ALiEM AIR Series | Vascular 2021 Module

By |Sep 26, 2021|Categories: Approved Instructional Resources (AIR series), Uncategorized|Tags: , , |

Welcome to the AIR Vascular 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 vascular emergencies in the Emergency Department. 9 blog posts met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 3 AIR and 6 Honorable Mentions. We recommend programs give 4.5 hours (about 30 minutes per article) of III credit for this module. AIR Stamp of Approval and Honorable Mentions   In an effort to truly [+]