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8 06, 2018

Trigger Point Injection for Musculoskeletal Pain in the ED

2018-06-07T20:29:26+00:00

Musculoskeletal pain is a common ED presentation and emergency providers can often manage it with NSAIDs alone.1 On the other hand, when patients present with small localized areas of intense muscle spasm called trigger points, NSAIDs won’t cut it. A trigger point injection (TPI), however, is a safe and easy way to treat the underlying cause of trigger point pain, and requires only basic equipment already available in most the EDs.

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4 06, 2018

Nuclear Attack: What Emergency Physicians Working in the ED Need to Know

2018-06-01T14:16:29+00:00

nuclear attackEver wonder what would happen if you were working in the emergency department (ED) when a nuclear attack happens? We’ve all had questions on boards or inservice exams about the long-term effect of radiation exposure, but would you know what to ACTUALLY DO if a nuclear attack happened? What do you do in the first few minutes? First few hours? We know that if you are in the immediate bomb vicinity, there is not much you can do. But what if you are 5 miles away? Or 10 miles?

If you look for information regarding nuclear attacks, there are no great summary resources on what to do in the immediate aftermath if you are in the ED. In order to bring this to you in an easily digestible format, we have broken this post up into a few topic areas: This blog post will cover (1) what physically happens in a nuclear attack and (2) what this means in the ED.

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3 06, 2018

IDEA Series | Chopped EM: A ‘Palatable’ Way to Teach a Challenging Topic to EM Residents

The Problem

idea series teaching residents quality improvement

Psychiatric and substance use disorder complaints comprise up to 12% of all Emergency Department (ED) visits.1–3 These conditions can present in a multitude of ways, making it essential for emergency physicians (EPs) to be aware of nuanced diagnostic characteristics of psychiatric illnesses in order to provide timely and appropriate care for these patients.

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31 05, 2018

ECMO for ARDS: Key Pearls for Emergency Physicians from the EOLIA Trial

2018-05-31T07:46:14+00:00

The role of extracorporeal membrane oxygenation (ECMO) in the management of acute respiratory distress syndrome (ARDS) has been a source of debate within the critical care community.1 The use of ECMO has steadily increased over the past decade;2 however, evidence to support the widespread adoption of this expensive and invasive technology is limited. As advances in ECMO technology have rapidly outpaced evidence, clinicians have been left to speculate as to ECMO’s true value. Is ECMO a promising tool to advance the care of patients with respiratory failure3 or an expensive distraction that has inappropriately supplanted evidence-based strategies?4

All who care for patients with ARDS have been eagerly awaiting the results of the Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome (EOLIA) trial which were recently published in May 2018’s New England Journal of Medicine.5

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30 05, 2018

Treating Opioid Withdrawal in the ED with Buprenorphine: A Bridge to Recovery

buprenorphineThe Emergency Department (ED) is the frontline of the opioid crisis, treating patients with opioid-related infections, opioid withdrawal, and overdose. These encounters can be difficult or even downright confrontational. But that does not have to be the case! With the use of buprenorphine, we can “flip the script” for these encounters, encouraging patient-provider collaboration in the treatment of opioid addiction as medical disease.

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28 05, 2018

Trick of the Trade: DIY Skyhook for Upper Extremity Swelling

2018-05-29T10:36:07+00:00

A 25 year-old male presents to the ED complaining of left upper extremity pain, redness, and swelling. His cat bit him 2 days ago and his symptoms started today. On exam he has impressive induration, erythema, and warmth to the dorsum of the hand and forearm. He is neurovascularly intact and able to range his joints freely. In addition to IV antibiotics, you would like to keep his arm elevated while in the hospital. What is an easy and simple way help ensure that this patient keeps his arm elevated?
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26 05, 2018

ALiEMCards: Tranexamic Acid

2018-05-26T21:29:25+00:00

Tranexamic acid (TXA) is a synthetic form of the amino acid lysine that binds to receptors on plasmin and prevents it from breaking down fibrin clots. Numerous studies have investigated its utility in preventing or treating traumatic hemorrhage, and the World Health Organization now includes TXA on its list of Essential Medicines. In addition to trauma, TXA may be effective in other clinical scenarios relevant to Emergency Medicine, including gynecological hemorrhage and epistaxis. ALiEM Cards: TXA, written by Dr. Sam Ashoo, reviews the dosing and potential indications for TXA use in the ED.

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