Maternal 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.
Tumor lysis syndrome (TLS) is an oncologic emergency characterized by life-threatening metabolic disturbances. Although it is most frequently associated with the treatment of hematological malignancies, its frequency may be increasing among patients with solid tumors. Emergency providers should be familiar with the presentation and treatment of these electrolyte abnormalities, which can lead to renal failure, seizures, and cardiac dysrhythmias. ALiEM Cards: Tumor Lysis Syndrome, written by Drs. Christopher Nash and Derek Monette, reviews TLS and the latest updates in its management.
Acute respiratory distress syndrome (ARDS) is a complex, life-threatening form of respiratory failure. It is responsible for almost 75,000 annual deaths in the United States.1Management remains lung-protective mechanical ventilation, an intervention that can begin in the ED. The Berlin Definition of ARDS has better predictive validity for mortality in comparison to previous definitions of ARDS.2 ALiEM Cards: ARDS, written by Dr. Michelle Lin, reviews the Berlin Definition and provides EPs with an on-shift resource to help manage critically-ill patients.
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.
Preeclampsia is on a spectrum of pregnancy related illness that includes eclampsia and HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets – debate exists about if this is a separate entity altogether). It carries a high mortality for both mom and baby, and can lead to a number of complications including pulmonary edema, hepatic rupture, placental abruption, and seizures (eclampsia). Created by Dr. Sam Ashoo, ALiEM Cards: Preeclampsia gives you a rapid review of its presentation, criteria, and management.
There is significant overlap among conditions that cause a red, painful, or red AND painful eye. Having trouble keeping them all straight? Need a refresher before heading in to see a patient with a new eye complaint? Check out our brief, practical ALiEM Cards on the topic:
- The Painful Eye (Author: Puja Gopal, MD)
- The Red Eye (Author: Michelle Lin, MD)
- Eye Differential Diagnoses (Author: Puja Gopal, MD)
In 2015 the Centers for Medicare and Medicaid Services (CMS) adopted the Sepsis Bundle Project, which is a quality improvement project aimed at reducing sepsis mortality by increasing compliance with national guidelines. But the CMS definitions of sepsis, differ from those is prominent trials (ProCESS, ARISE, ProMISE), and have since diverged from the Surviving Sepsis Campaign definitions, which may be different from your hospital guidelines! Also what are the criteria for SIRS, SOFA, qSOFA?
The ALiEM Card on Sepsis Definitions will help you keep it all straight.