Trick of the Trade: Directed Saline Irrigation for Nasal Suctioning
You are just starting out your mid-January evening shift, and you go to the room of an 8-month old male with nasal congestion. He is afebrile, and mildly tachycardic, but his lung exam is fairly benign and he’s breathing easily without retractions. You can clearly see he has congestion. You instruct the parents to use saline irrigation and then nasal suctioning to clear the congestion as needed, and they say, “How can we do this if our child struggles? Won’t we just end up with a wet, angry, and congested child?” [+]
SAEM Clinical Image Series: Fever and Aches
A 62 year old female with no past medical history presented to the ED with fevers, generalized weakness, severe muscle aches, and a rash. She had returned home from the Philippines 3 days prior to evaluation. Twenty-four hours prior to arrival, the patient noticed a rash on her shins. She denied any nausea, vomiting, diarrhea, abdominal pain, chest pain, shortness of breath, cough, sore throat, dysuria, urinary frequency, headache, and neck pain. The patient was in the Philippines for a family funeral and was indoors for most of the trip. She was unsure if she [+]
Peer Accountability: A Strategy for Maintaining Commitment to Personal and Professional Obligations
There are a number of personal attributes characterizing the professional identity of “physician.” We are dedicated to patients, committed to lifelong learning, and responsible for a variety of other professional obligations. Each requires physicians to be highly accountable – obligated or willing to accept responsibility for one’s actions. In this post we present examples of how we’ve adopted peer accountability as a strategy to help us with the myriad responsibilities and obligations at the heart of our profession. Just in time for the New Year – we challenge each of our readers to consider finding an “accountability partner” in 2020! [+]
EMRad: Can’t Miss Adult Wrist 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 common and catastrophic injuries. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially [+]
EMRad: Radiologic Approach to the Traumatic Wrist
This is EMRad, 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. Last post, we focused on the elbow. Now: the wrist. [+]
PECARN: Its relevance and importance in pediatric emergency care
Did you know that many of the landmark pediatric emergency medicine (EM) studies come from the Pediatric Emergency Care Applied Research Network (PECARN) collaborative? It works to address the challenging pediatric questions that only multicenter studies can. In this blog post, we highlight PECARN’s goal to translate, disseminate, and implement evidence to all providers of emergent and urgent care for pediatric patients. [+]
ALiEM Annual Report 2019: Innovation moves at the speed of trust
Before we launch too far into the 2020 year, we look back and celebrate our team’s successes and lessons learned from each of our projects and leaders. There are too many people who make the ALiEM efforts possible to include in our annual report, but we wish to publicly thank them all for their dedication towards education. Attached below is a glimpse into our team’s efforts and reach. [+]
ACMT Toxicology Visual Pearls: Painful Hand
What is the recommended treatment for a patient with this hand injury following a sting by the marine creature shown? [+]
Angela Rombola, MD
Carolinas Medical Center, Charlotte, NC
Latest posts by Angela Rombola, MD (see all)
SplintER Series: A Rare Cause of Traumatic Thumb Pain
A 45 year-old male presents with right thumb pain and deformity after falling off his bicycle. You obtain hand x-rays and see the following images. What is the most likely diagnosis, differential diagnosis, and management plan? Figure 1. AP and oblique views of the hand. Author’s own images. [+]
Victor Huang, MD
Teaming Tips 10: Resuscitate Your Meetings | ALiEM Faculty Incubator
Many of you are asked to take a leadership role in leading a team, whether it’s for research, administration, or even clinical. It is easy to feel unprepared for these roles, and there are many pitfalls waiting to sabotage your team’s productivity. The ALiEM Faculty Incubator has created a series of 10 case-based teaming problems to provide you with evidence-based advice and solutions for tackling some of the more common problems encountered in our professional team experiences. [+]