The following ultrasound video was obtained in a hypotensive 23 year-old man with a history of drug abuse. What drug of abuse when used chronically is most likely to lead to this ultrasound finding in an otherwise healthy patient?
Burnout is a well-known syndrome characterized by poor self-care, dehumanization, exhaustion, and reduced effectiveness. The study of wellness and resilience among emergency medicine (EM) providers and trainees has recently blossomed, largely as a consequence of recent tragedies of physician suicide, provider distress, and an increased awareness the impact burnout has on both personal and professional domains. While there are ongoing discussions on practices to best address burnout, methods have focused on promoting resilience, mindfulness, and provider engagement.1
(more…)End-tidal CO2 (EtCO2) monitoring is a measure of metabolism, perfusion, and ventilation. In the ED, we typically think of a EtCO2 as a marker of perfusion and ventilation. However, EtCO2 is an extremely powerful surrogate for endotracheal tube (ETT) Position, CPR Quality, Return of spontaneous circulation (ROSC), Strategies for treatment, and Termination (of CPR). Do these letters look familiar? They should! In this post we take a deep dive into each of these potential uses of EtCO2 in the ED.
(more…)A 28-year-old G4P3 at 41 weeks presents to the ED via EMS. She is in active labor. On exam, a neonatal head is visible. Two minutes later, you deliver a healthy vigorous baby boy and hand him to your colleague. You notice persistent bleeding from her vaginal canal. Her tachycardia climbs to 110 bpm and her latest blood pressure is 78/48 mm Hg. We review postpartum hemorrhage (PPH) and the 4 T’s – a memory aid to help ED providers manage this life-threatening presentation.
(more…)Welcome to the Non-ACS Cardiovascular Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the AIR Team is proud to present the highest quality online content related to non-acs cardiovascular emergencies. 5 blog posts within the past 12 months (as of September 2018) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 2 AIR and 3 Honorable Mentions. We recommend programs give 2.5 hours (about 30 minutes per article) of III credit for this module.
(more…)Cricothyroidotomy is an emergency life-saving procedure that involves surgical placement of a tube through the cricothyroid membrane in order to establish a patent airway for oxygenation and ventilation. The indications for this procedure are when traditional means, such as orotracheal or nasotracheal intubation, are contraindicated or have failed during attempts to establish an emergency airway.1,2 It is a critical skill for emergency physicians but the declining rate of this procedure has resulted in decreased exposure during training.3,4
(more…)After receiving numerous high-quality submissions, we are proud to announce the winners of the 2019 Essentials of Emergency Medicine (EEM) Education Fellowship contest! Dr. Tim Montrief from the Jackson Memorial/University of Miami Emergency Medicine residency program has won the blog post competition. A blinded EEM voting panel with input from ALiEM selected his winning post: Trick of the Trade: Bubble Study for Confirmation of Central Line Placement. We are thrilled to feature it today on the blog and look forward to meeting him in Las Vegas in May at the 3-day event. This weekend, we will also feature 2 other excellent submissions from runners-up Dr. Sarah Sanders (Northwestern University) and Dr. Jennifer Rabjohns (George Washington University). Thank you to everyone who submitted their work!
Dr. Tim Montrief
Emergency Medicine Resident
Jackson Memorial/University of Miami
