Can’t Miss ECG Findings for the Emergency Medicine Provider
Sudden cardiac death accounts for almost 400,000 deaths per year in the United States, and EM providers must be adept at discerning subtle, high-risk ECG findings. With the advent of triage ECG protocols, one of the most common interruptions in the ED is a request to “sign off” on an ECG. We present a reference of some of the most important high-risk ECG findings, intended to help ED providers systematically screen patients in triage and the waiting room. [+]
MEdIC Series: The Case of the Medication Mishap
Welcome to season 5, episode 9 of the ALiEM Medical Education in Cases (MEdIC) series! Our team (Drs. Tamara McColl, Teresa Chan, Eve Purdy, John Eicken, Sarah Luckett-Gatopoulos, Alkarim Velji, and Brent Thoma) is pleased to welcome you to our online community of practice where we discuss the practice of academic medicine! In our last case of the year, we present the scenario of a senior resident, Tim, who inadvertently administers an incorrect medication dose that leads to a serious adverse event. He then struggles with how to deal with this error as we often aren’t coached on situations like these throughout our training. Physicians aren’t allowed [+]
SplintER Series: Common ED Splint Techniques 104
The SplintER series is back with its fourth installment! In this series, we review splinting fundamentals, introduce advanced concepts, and highlight ways to implement these into your next shift. In this post, we summarize some of the most commonly deployed splints in the ED. Peer-reviewed by sports medicine experts (Dr. Kori Hudson and Dr. Anna Waterbrook), these injury-splint summary tables provide information on the origin, insertion, and positioning for each splint, along with the recommended number of layers of plaster. [+]
EM Fellowship Match Advice: Global Health Fellowship
EM Fellowship Match Advice is back to put the focus on Global Health Fellowships. A panel of 3 outstanding fellowship directors discuss the reasons why a resident may consider advanced training in this global health, future job opportunities, and the difference in approach between some of these programs. Hosted by Drs. Michael Gisondi and Michelle Lin, listen to the podcast to learn more about Global Health! Podcast Global Health Fellowship Program Director Panel Dr. Kristiana Kaufman (Wayne State University) Dr. Rebecca Walker (Stanford University) Dr. Hani Mowafi (Yale University) Listen to all the episodes of the EM Match Advice Series
ACMT Toxicology Visual Pearls: Snake Bite
Envenomation by the pictured snake would be expected to produce which clinical effects? Bradycardia and hypotension Bruising and epistaxis Difficulty swallowing and muscle weakness Severe swelling and blistering [+]
Director of Growth, Strategic Alliance Initiative, Center [+]
ALiEM AIR Series: Endocrine Module
Welcome to the Endocrine 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 Endocrine emergencies. 8 blog posts within the past 12 months (as of May 2018) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 2 AIR and 6 Honorable Mentions. We recommend programs give 3 hours (about 20 minutes per article) of III credit for this module. [+]
EM Match Advice: Program Directors Reflect on the 2018 Match
A new academic year is upon us! Across the country, emergency medicine interns are orienting to their new hospitals and preparing for their first day as “doctor.” But before we look forward, what lessons can we learn from 2018 EM Residency Match cycle? In this EM Match Advice series installment, Dr. Michael Gisondi (Stanford), Dr. Michelle Lin (UCSF), and an esteemed panel of program directors discuss how competitive EM was in 2018, the standardized video interview, and the number of programs an average applicant should apply to this year. Bonus: we introduce the Lin-Gisondi correction factor, a (mostly facetious) tool to [+]
PEM Practice Changing Paper: Clinical Trial of Fluid Infusion Rates for Pediatric DKA
Most protocols for managing pediatric patients with diabetic ketoacidosis (DKA) are based on a theoretical association between fluid resuscitation and subsequent neurological decline. Although the evidence for an association between IV fluids and cerebral edema comes from retrospective reviews, for over 20 years, it is an accepted teaching principle of pediatric DKA. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis, published just days ago in the New England Journal of Medicine, challenges this teaching with the first randomized controlled trial designed to investigate the relationship between IV fluids and cerebral edema. We review this publication and present a behind-the-scenes podcast interview [+]
MEdIC Series: The Case of the Overwhelmed Senior Resident – Expert Review and Curated Community Commentary
Our eighth case of season 5, The Case of the Overwhelmed Senior Resident, presented the scenario of a senior resident who felt overwhelmed when left to manage the department on a busy night shift while his attending physician was asleep in the back room. The resident debated whether to wake his attending to ask for help, but worried that it could be perceived as a sign of weakness or that he couldn’t “handle things” with autonomy. If you haven’t had a chance yet, we urge you to check out the case and share your thoughts on this important topic! The MEdIC [+]
The Myth of Vasopressors and Ischemia
Despite the widespread clinical use, and their well-documented life-saving properties, vasopressors are often maligned, accused of causing ischemia to fingers, toes, mesentery, kidneys, and so forth. Not only is the evidence that this happens poor, but, a fear of this dreaded complication can unwarrantedly lead good clinicians to limit or withhold potentially life- and organ-saving medications. This article showcases the importance of end-organ perfusion and explains how vasopressors may in fact be one of the most important therapies in an emergency physician’s armamentarium. [+]