Team-Focused CPR: Bringing Pre-hospital Success to the ED

High-quality chest compressions and early defibrillation are the cornerstones of effective cardiac arrest care.¹ When implemented correctly these two interventions enhance patient outcomes and improve overall survival.² However, despite simplified advanced cardiac life support (ACLS) algorithms and extensive training of providers, cardiac arrest scenarios in the emergency department (ED) are still high-stress and mortality rates remain high.^3,4

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By Blake Johnson, MD|2017-09-07T21:23:14-07:00Aug 13, 2017|Cardiovascular, Critical Care/ Resus, Expert Peer Reviewed (Clinical)|

Introducing In-Line Expert Peer Review: Advancing the State of Academic Blogging

A peer review process, in one form or another, has long been the de facto standard for academic publishing. In 2013, ALiEM was the first FOAM resource to initiate an attributed peer review process for all submitted content–effectively bringing a traditional standard to a new frontier of medical education.¹ Since our expert peer review (EPR) program inception, reviewers have published critical appraisals alongside 114 ALiEM posts to date.
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By Scott Kobner|2017-01-11T19:57:40-08:00Jan 12, 2017|Expert Peer Reviewed (Clinical), Social Media & Tech|

PV Card: Elbow Injuries

Elbow injuries are a common presentation to the Emergency Department. This pocket card reviews some the imaging, acute management, and some pearls for the following injuries: elbow dislocation, radial head subluxation, supracondylar fractures (such as the xray on the right), radial head fracture, epicondylitis, condyle fractures, and olecranon fracture. Thanks to Dr. Jonathon Hancock (Doctor’s Hospital orthopedist) for the expert peer review.

PV Card: Elbow Injuries

View other PV Cards.

By Melody Glenn, MD|2021-10-02T19:08:45-07:00Dec 12, 2016|ALiEM Cards, Expert Peer Reviewed (Clinical), Orthopedic|

PV Card: LVAD Complications

Patients with left ventricular assist devices (LVAD) often cause much anxiety amongst providers in the emergency department. This is understandable with all of the hardware, diminished or absent peripheral pulses at baseline, and potential for complications. To add to the already helpful reviews about LVADs at REBELEM and emDocs, this is a PV card set providing a methodical approach to troubleshooting LVAD complications, including a reproduction of an algorithm for managing the LVAD patient with altered mental status from EMCrit.^1–3

[Download PDF]

EXPERT PEER REVIEW: LVAD Complications

John Greenwood, MD
Assistant Professor
Department of Emergency Medicine
Department of Anesthesiology and Critical Care
Hospital of the University of Pennsylvania | Perelman SOM

Overall, a very well written summary for the ED provider faced with the challenge of managing the patient with an LVAD. These patients can be very complex, where the clinician may need to address a range of potential problems that can include hemodynamic complications, coagulopathy & bleeding, arrhythmias, and infection. After you initially assess the patient, the most important step is to task someone to get a hold of the VAD coordinator as they will often be able to guide you through any recent device changes and previous complications. The patient’s family can provide a wealth of information – use them! Knowing the most common complications will help guide your HPI, exam, and interventions so that you are well prepared for the next time a VAD patient presents to your ED.

Thumbnail LVAD image use approved by Mayo Foundation for Medical Education and Research

References

Partyka C, Taylor B. Review article: ventricular assist devices in the emergency department. Emerg Med Australas. 2014;26(2):104-112. [PubMed]
Andersen M, Videbaek R, Boesgaard S, Sander K, Hansen P, Gustafsson F. Incidence of ventricular arrhythmias in patients on long-term support with a continuous-flow assist device (HeartMate II). J Heart Lung Transplant. 2009;28(7):733-735. [PubMed]
Greenwood J, Herr D. Mechanical circulatory support. Emerg Med Clin North Am. 2014;32(4):851-869. [PubMed]

By Nicolas Stadlberger, MD|2021-10-02T19:11:24-07:00Nov 23, 2016|ALiEM Cards, Cardiovascular, Critical Care/ Resus, Expert Peer Reviewed (Clinical)|

PV Card: Algorithm for acute bronchiolitis management

Bronchiolitis is a common lower respiratory tract infection in children less than 2 years old, and especially in those 3-6 months old. In a collaboration with the American Academy of Pediatrics’ (AAP) Section on Emergency Medicine Committee on Quality Transformation, we present a PV card summarizing the Section’s “Clinical Algorithm for Bronchiolitis in the Emergency Department Setting” (reproduced with permission).¹ Dr. Shabnam Jain sums it up best in her expert peer review below: “In bronchiolitis, less is more.”
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By Michelle Lin, MD|2021-10-04T09:31:54-07:00Nov 7, 2016|ALiEM Cards, Expert Peer Reviewed (Clinical), Pediatrics, Pulmonary|

Trick of the Trade: Ear Irrigation in the Emergency Department

Ear irrigation is an important tool for adult and pediatric patients in the Emergency Department (ED) with ENT complaints. Irrigation can be used to clear ear cerumen, visualize tough-to-see tympanic membranes, and remove foreign bodies. This may reduce the need for subspecialist care and improve the patient’s hearing and quality of life.¹ Commercial electronic and mechanical devices are available for irrigation and have been studied. Moulton and Jones presented the improved efficacy of foreign body removal using an electric ear syringe in an (ED) population.² In this trick of the trade, we present a low cost and effective way of “ear-rigation” taught to us by one of our veteran nurses using easily available tools in the ED.

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By Chris Belcher|2016-11-11T19:47:00-08:00Aug 18, 2016|ENT, Expert Peer Reviewed (Clinical), Tricks of the Trade|

Bark Scorpion Sting: Indications for Anascorp and dosing controversies

The genus Centruroides, also known as the Bark Scorpion, is found throughout the southwestern United States and northern Mexico. Many emergency medicine practitioners in the Southwest are exceptionally familiar with the treatment of envenomation from Centruroides as a quarter million are reported annually^1,2. Although typically mild envenomations occur in adults, children and the elderly are at increased risk for severe complications³. The toxic syndrome consists of a sympathetic and parasympathetic storm that can result in myocardial damage, involuntary jerking, wandering eye movements, and most threatening – loss of airway.

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By Michael Sisson PharmD|2018-01-30T02:59:08-08:00Jul 27, 2016|Environmental, Expert Peer Reviewed (Clinical), Tox & Medications|