EMRad: Radiologic Approach to the Traumatic Knee
Radiology teaching during medical school is variable, ranging from informal teaching to required clerkships [1]. Many of us likely received an approach to a chest x-ray, but approaches to other studies may or may not have not been taught. We can do better! Enter EM:Rad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. We recently covered the elbow, wrist, shoulder, ankle, and foot. Next up: the knee. [+]
EMRad: Can’t Miss Adult Knee Injuries
Figure 1: Normal AP knee x-ray. Case courtesy of Dr Andrew Dixon, Radiopaedia.org, annotations by Stephen Villa MD. Have you ever been working a shift at 3am 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 [+]
Banishing Busy: Part 1
Medical professionals are busy people and exist in a constant state of “being busy.” How do we resolve chronic “busy-ness”? How do we manage our time effectively? In her recent talk at the CORD Academic Assembly 2020, Dr. Christina Shenvi, EM Physician and Associate Residency Director at UNC, provided 5 key actions to help us be productive, complete our work effectively, and strive for work-life balance. Dr. Shenvi recorded her lecture again to be shared with the ALiEM Faculty Incubator. This series of posts breaks down her talk into 3 sections in order to summarize [+]
PEM Pearls: Metered-Dose Inhaler versus Nebulizer
An 8-year-old is brought in by her parents with shortness of breath and wheezing. She’s been receiving her “rescue inhaler” at home and continues to have symptoms. You examine her and find that she has normal oxygen saturation, mild tachypnea and retractions, and diffuse wheezes. You think that she’s experiencing an acute asthma exacerbation. Given the current pandemic, and a recent report that administering nebulizer treatments to COVID-19 positive patients was correlated with transmission of COVID-19 to healthcare workers [1], what is the best way to treat the patient? [+]
ACMT Toxicology Visual Pearls: I’ll Huff and I’ll Puff…
The abuse of which common office supply substance can result in syncope and the EKG findings shown? Dust Off (difluoroethane) Elmer’s glue (polyvinyl acetate) Hand sanitizer (ethyl alcohol) Rubber cement (heptane, isopropyl alcohol) [+]
Kathryn T. Kopec, DO
Carolinas Medical [+]
Silence is not an option: Addressing structural racism in medical education
The year 2020 has been a year of upheaval. The COVID pandemic revealed disparities in healthcare and its effects on marginalized groups such as the Black community. The pervasive effects of structural racism affect all of us, including in medical education. We cannot and must not remain silent. As we honor Juneteenth, #BlackLivesMatter, and #WhiteCoatsforBlackLives, let us reflect on ways we can address racial injustice in our direct environment. [+]
Hydroxychloroquine Toxicity
As the COVID-19 pandemic continues to unravel, the role of hydroxychloroquine (HCQ) in the treatment of patients with this disease has been a major focus of discussion on the news and social media. Despite the lack of good data supporting its use in the clinical setting, there have been numerous reports of individual consumption of HCQ resulting in accidental overdose and even death. It is therefore important to recognize and manage patients who may present with HCQ toxicity. [+]
Trick of the Trade: Windex for Ring Removal
A 41-year-old male presents with left-hand pain after an altercation. The patient’s hand is noted to be swollen and tender, particularly over the 4th-5th metacarpals, with mild swelling extending to the 4th-5th digits. The patient also notes that he slightly deformed his wedding ring during the fight and he has since been unable to remove it. It’s a busy overnight and the patient has been in the waiting room for an hour. While waiting nursing staff had the patient ice his hand while elevated and attempted to remove the ring with a water-based lubricant. All attempts to remove the ring [+]
How I Stay Healthy in EM: Michael Paddock
Emergency medicine physicians serve on the “frontline” every time we walk into a shift but would be remiss to not acknowledge the unique challenges we have faced over the last few months, both as a specialty and as individual clinicians. Prevention of burnout and active wellness management is more important now than it ever has been. This month on our “How I stay Healthy” series, we’re featuring Dr. Mike Paddock, Staff Physician with the Regions Hospital EM residency program who shares his down-to-earth wisdom regarding what he does to thrive as a physician, educator, advocate, father, and friend. [+]
Trick of the Trade: Angiocatheter for manual aspiration of priapism
A 25-year-old man presents with 6 hours of penile pain and swelling after recreational penile injection of Trimix (alprostadil, papaverine, and phentolamine). He denies any history of sickle cell disease or penile trauma. On exam, he is in moderate discomfort and has a tumescent penis with a soft glans. You suspect the patient is suffering from ischemic, low-flow priapism. Manual compression and ice application have been attempted with no significant improvement in the patient’s clinical status. [+]