US4TW Case: 39F with Chest Pain

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this peer-reviewed case series, we focus on a real clinical case where bedside ultrasound changed the management or aided in the diagnosis. In this case, a 39-year-old female with history of lupus presents with chest pain.

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US4TW Case: 74F with Right Arm Tingling | Ultrasound for the Win series

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this peer-reviewed case series, we focus on real clinical cases where bedside ultrasound changed management or aided in diagnoses. In today’s case, a 74-year-old woman presents to the Emergency Department with painful right arm paresthesias.

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Esmolol Use in Cardiac Arrest

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There is an abundance of sympathetic stimulation in patients who present in ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) whether endogenously released as a stress response or exogenously administered in a resuscitation attempt.1 The hope is that sympathetic stimulation will increase the coronary and cerebral perfusion pressure of the patient and aid in resuscitation. However, there are numerous detrimental effects associated with epinephrine such as an increase in myocardial oxygen demand leading to increased ischemia.2

Contrary to traditional teaching, interesting evidence exists in both animal models as well as in limited reports in human subjects that show a potential benefit with beta blockade in cardiac arrest.

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2016-12-19T10:52:53-08:00

AIR Series: Peripheral Vascular Disease Module 2014

Welcome to the fourth ALiEM Approved Instructional Resources (AIR) Module! In an effort to reward our residents for the reading and learning they are already doing online, we have created an Individual Interactive Instruction (III) opportunity utilizing FOAM resources for U.S. Emergency Medicine residents. For each module, the AIR board curates and scores a list of blogs and podcasts. A quiz is available to complete after each module to obtain residency conference credit. Once completed, your name and institution will be logged into our private database, which participating residency program directors can access to provide proof of completion.

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PV Card: Focused Abdominal Aorta Ultrasound

UltrasoundIn this next ultrasound installment in the PV Card series, Drs. Victoria Koskenoja, Heidi Kimberly, and Mike Stone succinctly summarize the focused abdominal aorta ultrasound to assess for an abdominal aortic aneurysm (AAA). These can serve as key reference cards when you do your next AAA scan. Don’t miss the last card with tips on optimizing the view and common pitfalls.

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2017-08-03T00:21:42-07:00

Beta Blockers vs Calcium Channel Blockers for Atrial Fibrillation Rate Control: Thinking Beyond the ED

AFibIntravenous beta blockers and non-dihydropyridine calcium channel blockers are recommended first-line for atrial fibrillation (AF) with rapid ventricular rate (RVR) [1]. In a previous post, Bryan Hayes (@PharmERToxGuy) provided an overview of the data comparing beta blockers to calcium channel blockers for atrial fibrillation rate control in the ED. Here is part 2 of our two-part AF series. (more…)

2016-11-16T09:41:30-08:00

Diagnose on Sight: Swollen Upper Extremity in a Patient with End Stage Renal Disease

AV fistula pseudoaneurysmCase: A 45 year old female with end-stage renal disease presents with 2 days of worsening pain, swelling, and color change of her left upper extremity.  The symptoms began after her left arm arteriovenous (AV) fistula was accessed for hemodialysis. The skin is tense and a bruit is present. What is your diagnosis for this swollen upper extremity? Click on the image for a larger view.

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2016-12-22T20:07:29-08:00