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28 08, 2018

IDEA Series: Building a High Fidelity Biosimulation Task Trainer for Resuscitative Hysterotomy

The Problem

idea series teaching residents quality improvementThe peri-mortem cesarean section, rebranded in recent years as the “Resuscitative Hysterotomy”, is a potentially lifesaving procedure for both a pregnant mother and her child. It is both daunting and infrequently performed, necessitating frequent review of indications, techniques, and pitfalls to ensure the best possible outcome for mother and baby. The decision to perform this procedure should be made only in pulseless women with a uterine fundus above the umbilicus, which indicates a gestation of >20 weeks.1,2 Prior studies suggest the procedure should be performed within 5 minutes of maternal cardiac arrest in order to maximize the probability of favorable maternal neurologic outcome and the secondary goal of fetal survival.3 Given the paucity of clinical exposure to this potentially-life saving intervention, resuscitative hysterotomy is an ideal candidate for simulation-mediated deliberate practice.

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27 08, 2018

Ultrasound For The Win! – 57F with Chest Pain and Dyspnea #US4TW

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real clinical case where point-of-care ultrasound changed the management of a patient’s care or aided in the diagnosis. In this case, a 57-year-old woman presents with chest pain and dyspnea.

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23 08, 2018

SplintER Series: Tibial Plateau Fractures | Leg Day #1

2018-08-22T09:35:14+00:00

lipohemoarthrosis tibial plateau fracturesThe SplintER series is back with a new sub-series – Leg Day! We will review lower extremity orthopedic injuries, introduce advanced concepts, and highlight ways to implement these into your next shift. In this post, we summarize the appropriate way to evaluate, diagnose, and manage tibial plateau fractures. This post is peer-reviewed by Dr. Kori Hudson, one of our expert sports medicine colleagues! Please read below for her commentary.

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21 08, 2018

TLDR Book Review: “make it stick: The Science of Successful Learning”

2018-08-20T20:13:14+00:00

make it stickBookstore shelves and Amazon lists are filled with self-help titles that promise to make you a better manager, a better parent, or a better fishmonger. But most of them suffer from the same weakness: 2 pages of good practical advice is padded with 298 pages of filler.

Our new column TLDR (Too Long Didn’t Read) is a solution to what we call the McNugget Problem: trying to find the 5 bullet points of meaty goodness suspended within a mass of stale anecdotes, overcooked platitudes, and bad food analogies. Our TLDR goal is to find the critical take-aways in each book we review, and present them to you in a concise, easy-to-apply format. We read the books so you don’t have to!

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19 08, 2018

I am Dr. Cynthia Griffin, Flight Physician: How I Stay Healthy in EM

2019-02-19T18:52:20+00:00

Dr. Cynthia Griffin is an emergency physician and flight physician from Madison, Wisconsin. Dr. Griffin believes that laughter is the best medicine. When she’s not conquering the ED or saving lives in the sky, she can be found spending time with her family and her adorable chocolate lab. Here’s how she stays healthy in EM!

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10 08, 2018

Replace dolutegravir (Tivicay) with raltegravir (Isentress) for post-exposure prophylaxis

2018-08-10T04:08:00+00:00

raltegravirPost-exposure prophylaxis (PEP) of patients who may have been exposed to HIV includes a combination HIV nucleoside analog reverse transcriptase inhibitor emtricitabine/tenofovir (Truvada) plus an integrase inhibitor. The CDC initially recommended the integrase inhibitor dolutegravir (Tivicay). However on May 18, 2018, the CDC placed an alert about the neural tube defect risk with dolutegravir.1 How does this change our ED practice?
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8 08, 2018

ALiEM Cards: Maternal Cardiac Arrest

2018-08-08T10:46:09+00:00

pregnancy anatomy maternal cardiac arrestMaternal cardiac arrest is a low-frequency, high-risk pregnancy complication with 2 lives at stake. Incidence is approximately 1 in 12,000 to 50,000 pregnancies with a greater than 40% mortality rate. Understanding physiologic changes of pregnancy and how to perform a perimortem cesarean section (resuscitative hysterotomy) are critical aspects of caring for maternal cardiac arrest. ALiEM Cards: Maternal Cardiac Arrest, written by Drs. Jeffrey Sakamoto, Collin Michels, Nikita Joshi, and Rebecca Bavolek, reviews the causes, management pearls, and summarizes the perimortem cesarean delivery.

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