ALiEM AIR | Neurology 2019 Module

Welcome to the Neurology Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to neurological emergencies. 6 blog posts within the past 12 months (as of January 2019) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 1 AIR and 5 Honorable Mentions. We recommend programs give 3 hours (about 30 minutes per article) of III credit for this module. (more…)

ALiEM AIR | Stroke Module

Welcome to the Stroke 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 Stroke emergencies. 7 blog posts within the past 12 months (as of October 2018) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 0 AIR and 7 Honorable Mentions. We recommend programs give 3.5 hours (about 30 minutes per article) of III credit for this module.

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ALiEMU Capsules 12: Pharmacology of Intracranial Pressure Management

The newest installment in the popular ALiEMU Capsules series is live. This module focuses on the critical care topic of intracranial pressure management. Specific topics include hyperosmolar therapy with mannitol versus hypertonic saline and blood pressure management. Go to the ALiEMU Capsule and take the quiz for your Capsules certificate.

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2019-03-27T08:21:40-07:00

Reversing Anticoagulation to Administer Systemic Fibrinolytics for Ischemic Stroke: Pump the Brakes

Care of acute ischemic stroke patients is a complex and time-sensitive team effort. There is a potentially dangerous trend in the medical literature over the past few years that seems to be increasing as of late: reversing anticoagulation in order to administer systemic thrombolytic therapy. The purpose of this post is to highlight the available literature on this topic, specifically related to the direct acting oral anticoagulants (DOACs), and discuss why we should not support this practice (at least as of today).

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2018-11-11T02:28:19-07:00

PEM Practice Changing Paper: Clinical Trial of Fluid Infusion Rates for Pediatric DKA

Most protocols for managing pediatric patients with diabetic ketoacidosis (DKA) are based on a theoretical association between fluid resuscitation and subsequent neurological decline. Although the evidence for an association between IV fluids and cerebral edema comes from retrospective reviews, for over 20 years, it is an accepted teaching principle of pediatric DKA.

Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis, published just days ago in the New England Journal of Medicine, challenges this teaching with the first randomized controlled trial designed to investigate the relationship between IV fluids and cerebral edema. We review this publication and present a behind-the-scenes podcast interview with lead authors Dr. Nathan Kuppermann and Dr. Nicole Glaser from the Pediatric Emergency Care Applied Research Network (PECARN). (more…)

Podcast Follow-up: Interview with Dr. Debbie Yi Madhok, Co-Author of “Update on the ED Management of Intracranial Hemorrhage”

intracranial hemorrhage CT head epiduralIntracranial hemorrhage (ICH) is associated with significant disability and mortality. Although evidence-based guidelines exist, many hospitals have their own institutional practice patterns, which can make it difficult to care for these patients in the ED. Dr. Debbie Yi Madhok, an emergency physician and neurointensivist, sat down with Dr. Derek Monette, the ALiEM Deputy Editor in Chief, to discuss updates in the management of ICH. This interview follows up her original popular 2017 ALiEM post on dilemmas in ICH management, and takes a deeper dive into the nuances of seizure prophylaxis, blood pressure control, and platelet transfusions. We present the podcast and key learning points.
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2018-04-13T10:03:18-07:00

Herbal Induced Delirium: The Toxicologist Mindset

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

Case: A previously healthy 49-year-old woman presented to the emergency department (ED) with acute onset of confusion. Family members noticed her to have unsteady gait and she complained of blurry vision and difficulty urinating. She denied the use of any drugs or alcohol and took no medications. In the ED, her vital signs were: T 98.7, BP 95/59, P 130, RR 16, and O2 sat 100% on room air. Her pupils were 7 mm and reactive and her skin was dry. Bowel sounds were present. She had no focal neurological findings, but appeared “very confused” and “frightened.”

Serum electrolytes, CBC, and liver function tests were all unremarkable. She had a negative urine drug screen and alcohol level. The ECG demonstrated sinus tachycardia with normal intervals, and the brain CT  was normal.

What are your next thought processes?

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2018-04-04T03:33:39-07:00