Trick of the Trade: Combine Adenosine with the Flush
2019 literature update from this original 2012 Trick of the Trade post! The success of adenosine depends as much on the administration technique as it does the mechanism of action. The 2010 Advanced Cardiac Life Support (ACLS) Guidelines recommend the following when administering adenosine: “6 mg IV as a rapid IV push followed by a 20 mL saline flush; repeat if required as 12 mg IV push” This recommendation remained in the 2015 iteration. While most drugs are metabolized in the liver, adenosine doesn’t even make it that far, being metabolized in the erythrocytes and vascular endothelial cells. [+]
Measles 2019 Updates: The Comeback Kid
The child with a fever and rash in your Emergency Department (ED) may actually have measles. This year, there have been 1,182 cases of measles in the U.S., and counting. This is the highest rate in the past 27 years [1]. Globally, measles kills over a hundred thousand children [2]. In the U.S., one child dies for about every 1,000 cases [3]. Emergency providers must be able to quickly detect short-term complications that can lead to death and distinguish measles from mimics like Kawasaki Disease. It’s no coincidence that this year’s outbreak is in the setting of lower vaccination rates. [+]
2019-20 ALiEM Deputy Editor in Chief, Dr. Luz Silverio
With 1000+ posts over 10 years, we are thrilled to add 1 superstar to the ALiEM blog team. We officially announce Dr. Luz Silverio as our new Deputy Editor in Chief to help shape the direction and educational content of the blog. She graduated from the UCSF-SFGH Emergency Medicine Residency program, is an emergency physician at Kaiser Permanente at Santa Clara and a clinical assistant professor (affiliate) at Stanford University, hosts her own infrequently edited blog, Silverio Lining, has been a guest podcaster for EM:RAP and ERCast, serves as an Orthopedics Editor for DynaMed, and has had her watercolor artwork [+]
Pediatric Physical Examination: Tips & Techniques
In pediatrics, the history and physical examination is paramount. But even the most seasoned professional can have a challenge when facing a wiley 2-year-old. What strategies can you use to get in, get out, get the information you need, and maybe even make a (very small) friend in the meantime? [+]
Aditi Mitra, MD
University of Michigan
SAEM Clinical Image Series: Eye Trauma and Vision Loss
The patient is a 44-year-old male with a past history of end stage renal disease on hemodialysis, diabetes, and hypertension who presents with acute visual loss after assault 2 hours prior. He was struck in the eye by his partner’s fist (adorned with a large ring), but denies severe pain. He does endorses instant difficulty with his vision. There is no use of contacts or glasses. No other injuries, headache, or loss of consciousness are reported. [+]
SplintER Series: A Toddler’s Missed Step
A mother and father bring their 2-year-old boy to the Emergency Department after the child tripped over the family dog while running across the living room after a ball. He will not walk and points at his right lower leg and says it hurts (photo credit). [+]
Matthew Negaard, [+]
SAEM Clinical Image Series: Double Vision
Chief complaint: Double vision History of Present Illness: 61 year old female with history of HTN, DM, hyperlipidemia, and chronic low back pain presenting with double vision. She received an epidural spinal injection yesterday for the 4th time for low back pain. She was sedated for the procedure and woke up with headache, neck stiffness, and left eye “jumping around,” which progressed to double vision 1 hour later. There was no blurry or double vision with either eye closed. She had 1 episode of emesis. She presented to the ED 24 hours later [+]
SAEM Clinical Image Series: Bumps and Balls
A 31 year old African-American male, with a history of HIV, non-compliant with medications, presents with 3 months of painful “balls and bumps” on his left thigh. He was evaluated at another hospital prior to this visit and was discharged with 7 days of TMP-SMX. He denies any fever, chills, weight loss, night sweats, or anorexia. [+]
Anwar Ferdinand, [+]
EM Match Advice: How to “Swipe Right” this Interview Season
Applying for residency programs has often been compared to the modern world of dating. So in this 26th installment of the EM Match Advice series, we discuss finding the right-fit program for applicants using modern dating terminology. Join us in this fun and informative episode in navigating the residency match process. Podcast Episode A high-stakes component in a medical student's application for an emergency medicine (EM) residency is the Standard Letter of Evaluation, or SLOE. This is a standardized templated letter, written by an group (e.g. department) or faculty from an EM-residency program. This episode of EM Match Advice gives [+]
SplintER Series: A Case of Knee Pain
A 45-year-old male presents with right knee pain after he pivoted and felt a “pop” while making a move playing pickup basketball. You obtain knee x-rays and see a lateral irregularity in the AP view (photo courtesy of Dr. Gerry Gardner at Radiopaedia.org). What is the most likely diagnosis, commonly associated injury, and appropriate management plan? [+]
