Guideline Review: EAST Blunt Cerebrovascular Injury
Blunt Cerebrovascular Injury (BCVI) can be difficult to diagnose and potentially devastating to miss because of the risk of a potential ischemic stroke. The most recent (2010) Eastern Association for the Surgery of Trauma (EAST) guidelines reviewed 68 journal publications to create the following recommendations based on the best available evidence.1 We summarize the imaging and management recommendations most pertinent to the ED as an infographic for quick and easy reference.1,2 Of note: an isolated neck seat belt sign is NOT an indication for imaging! [+]
Teaming Tips Case 5: The Reluctant Collaborator | 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. [+]
EM Match Advice: Promoting Diversity and Inclusion in Training
Under-represented minorities (URM) in medicine continues to be a problem that many programs, especially in emergency medicine, are addressing head on with intentional, proactive strategies. Diversity matters. This EM Match Advice episode discusses how 3 different residency programs are championing for better representation through a variety of strategies. Podcast Episode < Expert Panelists Dr. Joseph Moll (Virginia Commonwealth) Dr. Tyson Pillow (Baylor) Dr. Bonnie Kaplan (Denver Health) Listen to all the episodes of the EM Match Advice Series Additional Reading Academy of Diversity and Inclusivity in Emergency Medicine (ADIEM) AAMC: 2018-19 Applicants and Matriculation Data CORD: The Underrepresented Applicant Emergency [+]
ALiEMU Capsules 12: Pharmacology of Intracranial Pressure Management
The newest installment in the popular ALiEMU Capsules series is live. This module focuses on the critical care topic of intracranial pressure management. Specific topics include hyperosmolar therapy with mannitol versus hypertonic saline and blood pressure management. Go to the ALiEMU Capsule and take the quiz for your Capsules certificate. [+]
TLDR Book Review: Switch – How to Change Things When Change is Hard
Chip and Dan Heath’s book, Switch, explains why change is so difficult and what we can do to make it easier. This little book is a must-read if you’ve ever met inexplicable resistance addressing issues as trivial as buying a new brand of coffee for the break room or as significant as enforcing the mandatory use of hand sanitizer. Is anyone actually in favor of spreading communicable diseases? Do the absence of San Francisco Hazelnut Morning Blend really warrant a call to the department chair? Why would people be so opposed to undeniably positive changes? The answer lies in understanding [+]
SAEM Research Learning Series: Writing a Winning Abstract for a Scientific Meeting
In this podcast episode of the SAEM Research Learning Series, Drs. Mary and Nate Haas interview Daren M. Beam, MD MS (Indiana University) talk about his research career. Listen to this episode which is chock full of practical pearls to help you get ahead with submitting a winning abstract for a scientific meeting or conference. As a bonus, you will also hear behind-the-scenes stories about how the PE Rule-out Criteria (PERC) rule came to be while he was a research coordinator before medical school. Did you know that it was originally nicknamed the “PE Pink Sheet”? [+]
ACMT Toxicology Visual Pearls: Don’t Go Breaking My Heart
The following ultrasound video was obtained in a hypotensive 23 year-old man with a history of drug abuse. What drug of abuse when used chronically is most likely to lead to this ultrasound finding in an otherwise healthy patient? [+]
Jennifer Pallansch, MD
Department of Emergency Medicine
Carolinas Medical Center
IDEA Series: A Workshop to Reflect on Personal Resilience
The Problem Burnout is a well-known syndrome characterized by poor self-care, dehumanization, exhaustion, and reduced effectiveness. The study of wellness and resilience among emergency medicine (EM) providers and trainees has recently blossomed, largely as a consequence of recent tragedies of physician suicide, provider distress, and an increased awareness the impact burnout has on both personal and professional domains. While there are ongoing discussions on practices to best address burnout, methods have focused on promoting resilience, mindfulness, and provider engagement.1 [+]
End-Tidal CO2 in Cardiopulmonary Resuscitation
End-tidal CO2 (EtCO2) monitoring is a measure of metabolism, perfusion, and ventilation. In the ED, we typically think of a EtCO2 as a marker of perfusion and ventilation. However, EtCO2 is an extremely powerful surrogate for endotracheal tube (ETT) Position, CPR Quality, Return of spontaneous circulation (ROSC), Strategies for treatment, and Termination (of CPR). Do these letters look familiar? They should! In this post we take a deep dive into each of these potential uses of EtCO2 in the ED. [+]
The 4 T’s of Postpartum Hemorrhage
A 28-year-old G4P3 at 41 weeks presents to the ED via EMS. She is in active labor. On exam, a neonatal head is visible. Two minutes later, you deliver a healthy vigorous baby boy and hand him to your colleague. You notice persistent bleeding from her vaginal canal. Her tachycardia climbs to 110 bpm and her latest blood pressure is 78/48 mm Hg. We review postpartum hemorrhage (PPH) and the 4 T’s – a memory aid to help ED providers manage this life-threatening presentation. [+]