The safe placement a central venous catheter (CVC) remains an important part of caring for critically ill patients.1 Over 5 million CVCs are placed each year in the United States. It is crucial to confirm that the central line is placed in the correct position in order to rule out potential complications of the procedure (e.g. pneumothorax) and begin administration of life-saving medications. Post-procedure chest radiographs (CXR) are the standard of care for CVC placements above the diaphragm. However, the annual cost to the U.S. healthcare system for CXRs after CVC placement is estimated to be over $500 million.2 Further, in a busy ED, the limited availability of portable radiography may pose a considerable time delay. Radiography may also be limited in resource‐poor and austere settings, particularly the prehospital and military environments. We review a faster, cheaper, and more accurate alternative for evaluating CVC placement: point of care ultrasound (POCUS).(more…)
Symptomatic influenza A and B infections cause worldwide morbidity and mortality every year. Annual vaccination remains the greatest prophylactic measure, but the vaccine is not 100% effective due to mismatch between the circulating and vaccine virus strains. Although most individuals will recover from influenza without incident, some specific patient populations are at high risk for severe complications. The Infectious Disease Society of America (IDSA) recently updated their clinical practice guidelines.1 We review these key updates, including recommendations on who to test, treat, and provide chemoprophylaxis.(more…)
A 32 year old woman arrives in your emergency department after being in a motor vehicle collision where she was the seat-belted driver. She undergoes chest CT imaging despite a negative chest x-ray because of her ongoing anterior chest wall diffuse tenderness. You discover a small 10% pneumothorax (PTX), but no other associated thoracic injuries. Should you place a tube thoracostomy (chest tube)? Should this patient be admitted to the hospital? A 2019 Annals of Emergency Medicine paper by the NEXUS Chest research group tackles these questions.1
An 85 year-old man presented with coma after ingestion of a household product. Two key axial views of his brain MRI are shown. Which of the following did he ingest?
- Apple cider vinegar
- Drain cleaner
- Ethylene glycol
- Hydrogen peroxide
Emergency Medicine (EM) residents are expected to be familiar with and competent in performing a wide number of procedures, including rare ones such as performing an escharotomy in a patient with severe burns. Unfortunately, there is a paucity of readily available simulation models to facilitate practice of this rare yet potentially life-saving skill.
In this podcast episode of the SAEM Research Learning Series, Drs. Mary and Nate Haas interview Zackary Meisel, MD, MPH, MSHP from University of Pennsylvania (research bio). In this episode, Zack shares practical advice, framed by his own personal path to building a successful research career. Listen to how he evolved from originally being a prehospital researcher to carving a unique niche in research on evidence-based narratives.
My 2017 new year’s resolution was to create brief educational pearls on shift called Post It Pearls, which I published to Twitter. I have increasingly noticed that many of my target learners are not on Twitter. They are, however, on Instagram. So this year’s resolution is to test out how whether Post It Pearls would reach more learners and thus be more impactful on my Instagram account (@MichelleLinMD).