26 10, 2016

Magnesium for Rapid Atrial Fibrillation Rate-Control in the ED

By | October 26th, 2016|Cardiovascular, Tox & Medications|0 Comments

magnesium-ivWe love magnesium in the Emergency Department. It’s been said that magnesium is second-line for everything (kind of like doxycycline). But what about rate/rhythm control in atrial fibrillation (AF)? The 2014 AHA/ACC/HRS guideline for the management of patients with AF don’t mention magnesium at all.1 Dr. Josh Farkas (@PulmCrit) wrote about magnesium infusions for atrial fibrillation and torsade last year. His post looked at its use for cardioversion, rhythm-control, and rate-control in critically-ill patients. Our post will focus specifically on the IV magnesium data for rate-control in ED-related settings.

Over the years, IV magnesium has been studied for the treatment of rapid AF in several clinical situations, most prominently in post-cardiac surgery patients. However, there are also studies in ED and cardiology patients, both as a primary therapy and as an adjunct. In fact, two meta-analyses from 2007 evaluated the data (mostly the same studies).2,3 Both concluded that magnesium is safe and effective in controlling ventricular rate in rapid AF compared to placebo, the latter in patients also receiving digoxin. A closer look at the meta-analyses reveals that the positive rate control effect for magnesium seems to be driven by the placebo-controlled trials.4 Similarly, the positive benefit of magnesium in rhythm control is largely derived from trials versus placebo or traditional rate-control medications (e.g., beta-blockers or calcium channel blockers) rather than amiodarone or other rhythm-control agents. Of the 11 studies cited in the meta-analyses, only five reported rate-control data in ED-related settings. 


24 10, 2016

IDEA Series: The “Knowledge Bomb” Highlights Clinically Relevant Research

By | October 24th, 2016|IDEA series|1 Comment|Editors: Mary Haas, MD

idea series - team based learning

The Problem

Residents continually face the challenge of keeping up to date with relevant medical literature in the midst of the rigors of completing medical residency. In addition, application of new medical knowledge obtained from reviewing recent research can be challenging and is a difficult skill to teach.

Residency provides a unique experience for individual learners based on each learner’s personal interests, interactions with other learners and faculty, and patient encounters. Often, residents achieve their best research and article discovery when prompted by specific patient encounters. A forum for individual residents to share knowledge gained from research prompted by these encounters is needed.


19 10, 2016

52 Articles in 52 Weeks (2nd edition, 2016)

By | October 19th, 2016|Clinical, Medical Education|1 Comment

journal-articles-canstockphoto3359042-200x300Maintaining lifelong learning is challenging, especially when trying to keep up with all of the journal publications in emergency medicine (EM). In 2013, we published a compilation of 52 journal articles, which interns could read over a 52-week period, at an average pace of 1 journal article per week. In the list below, we present an updated compilation for the “52 Articles in 52 Weeks” initiative.


17 10, 2016

Whipped Cream Charger Abuse: The Toxicologist Mindset

By | October 17th, 2016|Tox & Medications|3 Comments

whipped cream chargerThe Toxicologist Mindset series features real-life cases from the San Francisco Division of the California Poison Control System.

Case: A 39-year-old man, with no significant past medical history, was brought to the emergency department by family members, over three consecutive days, for anxiety, confusion, and ataxia. In the first two visits, his laboratory work-up, including complete blood cell count, chemistry panel, liver function tests, urine drug screen, and non-contrast head CT, were unremarkable. On his third visit, he was profoundly encephalopathic with confusion and poor concentration. He had bilateral lower extremity weakness and ataxia. He was admitted to the neurology service for further work up. Additional history revealed that hundreds of empty canisters of whipped cream chargers were found in his house.


16 10, 2016

ALiEM Book Club: On The Move

By | October 16th, 2016|ALiEM Book Club|0 Comments|Editors: Jordana Haber, MD

Oliver Sacks On the Move“I am a storyteller, for better and for worse. I suspect that a feeling for stories, for narrative, is a universal human disposition, going with our powers of language, consciousness of self, and autobiographical memory.” —Oliver Sacks, On the Move

Oliver Sacks has been many things in his life—physician, writer, researcher, drug addict, power lifter, motorcycle lover. He writes about all of these experiences as they have arced across the course of his much varied life in his memoir, On the Move [Amazon]. In this colorful autobiography, Sacks bobs and weaves through his own life, at times focusing in on the smallest detail, and at others zooming back for the 10,000 foot benefit of hindsight. Parts of the book are starkly innocent, while others border on frank arrogance. He demonstrates a complexity of personal characteristics that is at once believable and larger-than-life.


15 10, 2016

Introducing CME for ALiEM via FOAMbase

By | October 15th, 2016|CME, Medical Education, Social Media & Tech|0 Comments

foambase-aliem-logo-sml cmeEver wish you could get Continuing Medical Education (CME) credit for the Free Open Access Meducation (FOAM) you already consume? We are excited to announce that 10 ALiEM articles are now available for AMA PRA Category 1 CME. This is a pilot program in collaboration with FOAMbase and EB Medicine. There is great content on trauma, geriatrics, pediatrics, critical care, and more. We think CME for FOAM is going to be a great way to increase sustainability for FOAM authors while keeping FOAM 100% free and open access.



14 10, 2016

MEdIC: Case of Cognitive Overload – Expert Review and Curated Community Commentary

By | October 14th, 2016|MEdIC series|2 Comments

cognitive overloadThe Case of Cognitive Overload outlined a scenario of a junior resident dealing with the harsh realities of working in emergency medicine when she experiences the negative impacts of cognitive overload while caring for a sick patient. This month, the MEdIC team (Tamara McColl, Teresa Chan, Sarah Luckett-Gatopoulos, Eve Purdy, John Eicken, and Brent Thoma), hosted a discussion around this case with insights from the ALiEM community. We are proud to present to you the Curated Community Commentary and our 2 expert opinions. Thank-you to all participants for contributing to the very rich discussions surrounding this case!