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 [+]
Herbal Induced Delirium: The Toxicologist Mindset
The Toxicologist Mindset series features real-life cases from the San Francisco Division of the California Poison Control System. Case: A previously healthy 49-year-old woman presented to the emergency department (ED) with acute onset of confusion. Family members noticed her to have unsteady gait and she complained of blurry vision and difficulty urinating. She denied the use of any drugs or alcohol and took no medications. In the ED, her vital signs were: T 98.7, BP 95/59, P 130, RR 16, and O2 sat 100% on room air. Her pupils were 7 mm and reactive and her skin was dry. Bowel [+]
The 2018-19 Chief Resident Incubator enrollment opens TODAY
We are incredibly proud and excited to announce the launch of the 2018-19 ALiEM Chief Resident Incubator. Emergency medicine (EM) Chief Residents have recently been selected across North America to help shape and lead EM residency programs. The "CRincubator" will be enrolling its fourth class, building quickly on lessons learned and ongoing feedback from the membership. Led by Dr. Tanner Gronowski (Chief Operating Officer) and Dr. Robert Cooney (Chief Strategic Officer), this group will also feature legacy advisors, senior advisors, all-star cast of returning alumni champions, several surprise virtual mentors. Thanks to our exclusive sponsors EBSCO Health / DynaMed Plus. [+]
MEdIC Series: The Case of the Post-Paternity Leave Blues
Welcome to season 5, episode 6 of the ALiEM Medical Education in Cases (MEdIC) series! Our team (Drs. Tamara McColl, Teresa Chan, John Eicken, Sarah Luckett-Gatopoulos, Eve Purdy, 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 of a young attending physician anxious to return to clinical work after taking a 6-month paternity leave. Check out the case and join the conversation in the comments section! We’d love to hear your thoughts on this important topic! [+]
10 Tips to Improve Patient Satisfaction in the Emergency Department
Exceptional communication is essential when providing care to patients in the ED. This is especially true given that we don’t have a preexisting relationship with our patients. They have never seen us before, have little or no information about us, and didn’t choose us. They are typically anxious, uncomfortable, and would probably rather be somewhere else. Exceptional communication allows patients to gain trust in us, in our skills, and in our recommendations. Strong communication skills not only allow physician and non-physician staff to gather relevant information and share important findings, but also help improve healthcare outcomes, reduce misunderstandings, and minimize [+]
PEM Pearls: Red Flags for Child Abuse – Case 1
Child abuse is a common cause of pediatric morbidity and mortality. In 2015, over 650,000 children were found to be victims of maltreatment and over 1,500 child deaths occurred due to child abuse or neglect in the United States.1 Children under 1 year of age are at the highest risk of abuse with potential for lifelong sequelae. Emergency department providers are in a unique position to recognize child abuse and take appropriate steps to reduce further injury to children. An understanding of the motor development of young children can aid physicians in the identification of clinical red flags in the [+]
A Can’t Miss ED Diagnosis: Euglycemic DKA
A middle-aged man with a history of diabetes and hypertension presents with nausea, vomiting, and shortness of breath. His laboratory testing is remarkable for a leukocytosis, ketonemia, and an anion gap acidosis (pH of 7.13). The EM resident caring for this patient is surprised to find that the blood glucose is 121 mg/dL. Which home medication is likely responsible for this presentation? Metformin Glipizide Liraglutide Canagliflozin Canagliflozin: An SGLT2 Inhibitor The patient's presentation is consistent with diabetic ketoacidosis (DKA) in the absence of hyperglycemia. This entity is known at euglycemic DKA and it is increasingly recognized for an association with [+]
3rd Annual Emergency Medicine Wellness Week | 2018 Highlights
We are set to wrap-up the 3rd Annual Emergency Medicine Wellness Week. The ALiEM Wellness Think Tank (WTT) collaborated with CanadiEM, ACEP, and the Canadian Association of Emergency Physicians (CAEP) to encourage participation from EDs across North America and around the world. Many of you shared your individual and group successes, which have helped to build collective wellness across the specialty. We are proud to present some of the Wellness Week highlights, and remain hugely motivated to participate in this important movement! When you’re done reading, be sure to welcome today’s newly matched EM interns with the hashtag #WelcometoEM! [+]
Resilience in EM Despite Litigation: An Interview with Dr. Gita Pensa
You have just signed out from one of the best shifts in your career. You feel like you were born to do this! You’re a great EM doctor! Then, you spot him, a man in a dark suit making eye contact as you walk through the lobby towards the exit. He stops and asks, “Are you Dr. About-to-get Sued?” Being named in a malpractice lawsuit is a potentially devastating, frequently unmentioned, and yet rather common event in EM. Providers may find themselves feeling isolated and ashamed, questioning their career choice regardless of the trial outcome. Members of the ALiEM Wellness [+]