Ketamine for Severe Ethanol Withdrawal: A New Hope?
Ethanol withdrawal is a complex disease state. Two of the main players are GABA (an inhibitory neurotransmitter) and glutamate (an excitatory transmitter that can act on NMDA receptors). Simplistically, chronic ethanol use leads to a down-regulation of GABA receptors and an up-regulation in glutaminergic receptors, such as NMDA. When ethanol is abruptly discontinued, we are left with a largely excitatory state with less ability for GABA-mediated inhibition and more capacity for NMDA/glutamate-mediated excitation. While much of the treatment of severe ethanol withdrawal is focused on GABA, there are agents, such as phenobarbital and propofol, that can suppress the glutaminergic response. [+]
MEdIC Series: The Case of the Orphaned Patient – Expert Review and Curated Community Commentary
Our seventh case of season 5, The Case of the Orphaned Patient, presented the scenario of a junior orthopedic surgery resident rotating in the ED and receiving significant pushback when trying to transfer the care of a clinically deteriorating patient to a more appropriate service. The outcome of this pushback was a patient without a service feeling primarily responsible for further care, leaving the patient “orphaned” in the ED. 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 team (Drs. Tamara McColl, Teresa Chan, Sarah Luckett-Gatopoulos, Eve [+]
How Competitive was Emergency Medicine in the 2018 Match? The answer might surprise you.
The National Residency Matching Program® (NRMP) recently published its annual Results and Data for the 2018 Main Residency Match®. How competitive was emergency medicine (EM)? Spoiler alert: not much changed! But to understand the full picture, we need to dive into the numbers, which look a lot different from last year. Below is a summary of the most pertinent results for EM, trended from 2011-2018. You will notice some striking differences in the data between the 2017 Match and the 2018 Match. [+]
Confronting Stress Before and After High Acuity Shifts: A Discussion with Performance Psychologist Dr. Jason Brooks
It’s almost the end of your sixth shift in a row. You are trying to finish up notes when you hear an overhead page. You find yourself in the middle of a pediatric code that has a poor outcome and you have 5 minutes to spend with the family before being pulled into another patient’s room. You have no time to address the difficult case you just encountered. As an emergency physician, this may happen on a daily basis but some cases hit closer to home. How do you recover after these shifts, and how do you prepare for the [+]
MEdIC Series: The Case of the Orphaned Patient
Welcome to season 5, episode 7 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! This month, we present a case that seems to have become a more common occurrence as patient flow has increased and hospitals must function beyond capacity. The case describes a junior resident tasked with transferring the care of a clinically deteriorating patient to another service. She unfortunately receives significant pushback resulting in no primary service [+]
WELCOME to the ALiEM Faculty Incubator 2018-2019 Class
We had an AMAZING kick-off this week at the Council of Emergency Medicine Residency Directors (CORD) Academic Assembly, welcoming our NEW 2018-19 ALiEM Faculty Incubator Class of Educator-Scholars! We received applications from across the country and internationally from budding scholars with a broad range of background and experiences. We narrowed it down to the top 32 applicants, who we know are rising leaders in education scholarship. [+]
MEdIC Series: The Case of the Post-Paternity Leave Blues – Expert Review and Curated Community Commentary
Our sixth case of season 5, The Case of the Post-Paternity Leave Blues, presented the scenario of an early-career attending physician anxious to return to clinical work after taking a 6-month paternity leave. 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 team (Drs. Tamara McColl, Teresa Chan, Sarah Luckett-Gatopoulos, Eve Purdy, John Eicken, Alkarim Velji, and Brent Thoma), hosted an online discussion around the case over the last 2 weeks with insights from the ALiEM community. We are proud to present to you the curated [+]
ALiEM AIR Series: Ear, Nose, and Throat (ENT) Module
Welcome to the Ear, Nose, and Throat (ENT) 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 ENT emergencies. 8 blog posts within the past 12 months (as of December 2017) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 1 AIR and 7 Honorable Mentions. We recommend programs give 3 hours (about 20 minutes per article) of III credit for this module. [+]
ACMT Toxicology Visual Pearls: Spider Bite
A patient presents to the ED for management of a spider bite. Which of the following statements is correct regarding a bite from the spider pictured? Laboratory studies can be helpful in management and predicting outcome. Antibiotics are recommended. The venom is cytotoxic and can cause red blood cell hemolysis. The venom is more potent on a volume-per-volume basis than the venom of a pit viper. [+]
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Podcast Follow-up: Interview with Dr. Debbie Yi Madhok, Co-Author of “Update on the ED Management of Intracranial Hemorrhage”
Intracranial hemorrhage (ICH) is associated with significant disability and mortality. Although evidence-based guidelines exist, many hospitals have their own institutional practice patterns, which can make it difficult to care for these patients in the ED. Dr. Debbie Yi Madhok, an emergency physician and neurointensivist, sat down with Dr. Derek Monette, the ALiEM Deputy Editor in Chief, to discuss updates in the management of ICH. This interview follows up her original popular 2017 ALiEM post on dilemmas in ICH management, and takes a deeper dive into the nuances of seizure prophylaxis, blood pressure control, and platelet transfusions. We present the podcast and [+]