PEM Pearls: Hydrocortisone stress-dosing in adrenal insufficiency for children

During your shifts in the pediatric ED, you may encounter a few patients with adrenal insufficiency or adrenal crisis. Some of the most common causes include those patients with Addison disease, pituitary hypothalamic pathology, and those patients on chronic steroids. When these patients get sick or sustain trauma, it is important to consider giving them a stress dose of hydrocortisone. Patients in adrenal insufficiency or crisis can present with dehydration, weakness, nausea, vomiting, confusion, lethargy, and severe hypotension refractory to vasopressors. ^1–3

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By Delphine Huang, MD|2017-10-26T14:34:06-07:00May 2, 2016|Endocrine-Metabolic, Pediatrics, PEM Pearls|

Synthetic cannabinoid use reaches new heights: K2 is not just a mountain on the China-Pakistan boarder

You are working a shift in the emergency department, and you hear the ambulance sirens. EMS is bringing you two patients, friends from a nearby shelter. Per report, the two men were “smoking drugs” together outside of the shelter. Bystanders noted that the 29-year-old man became increasingly agitated, shouting, banging on the door, and threatening his other shelter mates, while the other, a 50-year-old man, laid down on the sidewalk. EMS also reports picking up these patients in an area known for high “K2” use.

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By Denise Fernandez, MD|2017-03-05T14:18:46-08:00Apr 27, 2016|CME, Tox & Medications|

Did the Affordable Care Act actually reduce ED visits as politicians promised?

The Affordable Care Act (ACA) was supposed to expand coverage to the uninsured and many politicians claimed this would result in lower use of “expensive emergency rooms” for the treatment of patients’ acute complaints. Ignore, for the moment, the controversy about whether or not the emergency department (ED) is an expensive or appropriate place for patients to seek care. A new survey [PDF] from the Center for Disease Control and Prevention (CDC), asked the question: Did the ACA actually reduce ED visits as politicians promised?¹

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By Cedric Dark, MD MPH|2016-12-20T12:28:25-08:00Apr 26, 2016|Public Policy|

Ultrasound For the Win! Case – 43-year-old Man with Syncope #US4TW

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 this case, a 43-year-old man presents to the Emergency Department after a syncopal episode.

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By Peter Reardon, MD|2017-07-19T00:06:51-07:00Apr 21, 2016|Cardiovascular, Ultrasound, Ultrasound for the Win|

AIR Pro Series: Critical Care, Part 1 (2016)

Below we have listed our selection of the 12 highest quality blog posts related to 5 advanced level questions on critical care topics posed, curated, and approved for residency training by the AIR-Pro Series Board. The blogs relate to the following questions:

Ultrasound fluid assessment
Ultrasound in critical care
Vasopressors for critical care patients
Peripheral intravenous vasopressor administration
Extracorporeal membrane oxygenation basics

In this module, we have 8 AIR-Pro’s and 4 honorable mentions. To strive for comprehensiveness, we selected from a broad spectrum of blogs identified through FOAMSearch.net.

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By Fareen Zaver, MD|2017-07-21T09:52:08-07:00Apr 20, 2016|Approved Instructional Resources PRO (AIR-Pro Series), Critical Care/ Resus|

AIR Series: Cutaneous Module

Welcome to the Cutaneous 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 cutaneous content. Below we have listed our selection of the 4 highest quality blog posts within the past 12 months (as of February 2015) related to dermatology emergencies, curated and approved for residency training by the AIR Series Board. More specifically in this module, we identified 0 AIRs and 4 Honorable Mentions.

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By Andrew Grock, MD|2017-03-05T14:14:16-08:00Apr 18, 2016|Approved Instructional Resources (AIR series), Dermatology|

Trick of Trade: Build-it-yourself IV Fluid and Drug Administration Trainer

Simulation equipment can be rather expensive and wanting to practice fluid and drug administration does not always warrant the purchase of specialized equipment. Luckily, a simple administration trainer can be made in less than 10 minutes and only costs a few dollars (or even nothing). This is an ideal option for resuscitation training if you are already using a manikin without IV arms or an IO option. Learners can practice preparing infusions and administering fluid or preparing an injection and administering it via the syringe port. This trainer can have multiple IV cannulas in one lid and can even include an intraosseous cannula, such as an EZ-IO.

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By Christoph Schroth|2016-10-26T17:04:20-07:00Apr 14, 2016|Expert Peer Reviewed (Clinical), Tox & Medications, Tricks of the Trade|

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