PV Card: Emergency Drug Cards for Adults and Children

Rob Bryant, MD (@RobJBryant13), Amie Hatch, PharmD, BCPS (@Amie_EMPharmD), and Jeremy Bair, PharmD (@bairpharm) from Intermountain Healthcare in Utah have created and adopted a fantastic medication reference card which is used by physicians and nurses in the Emergency Department. The medications were chosen because they are often prone to dosing errors and require time-sensitive ordering. They generously offered to share this incredibly compact resource for free to the Emergency Medicine community as a PV card. If you see them, give them a high-five.

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By Michelle Lin, MD|2021-10-06T19:44:45-07:00Sep 11, 2013|ALiEM Cards, Expert Peer Reviewed (Clinical), Tox & Medications|

Patwari Academy videos: PALS

Pediatric Advanced Life Support (PALS) guidelines were most recently reviewed in Circulation 2010 ¹ based on the International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science which includes treatment recommendations. Dr. Rahul Patwari nicely summarizes these findings in this series of 8 videos

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By Michelle Lin, MD|2019-01-28T21:55:35-08:00Sep 8, 2013|Patwari Videos, Pediatrics|

High Sensitivity Troponin Testing

Troponin testing is an important component of the diagnostic workup and management of acute coronary syndromes (ACS). The increasing sensitivity of troponin assays has lowered the number of potentially missed ACS diagnoses, but this has also created a diagnostic challenge due to a decrease in the specificity of the test. From 1995 to 2007, the limit of troponin detection fell from 0.5 ng/mL to 0.006 ng/mL (see below graph). Robert Jesse summed up this frustration with the following quote:

When troponin was a lousy assay it was a great test, but now that it’s becoming a great assay, it’s getting to be a lousy test.

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By Salim Rezaie, MD|2019-09-10T13:35:54-07:00Sep 5, 2013|Cardiovascular|

Are Acetaminophen Levels Necessary in All Overdose Patients?

Intentional overdose patients are notorious for giving inaccurate histories. “I took 14 tablets of this and 8 capsules of that. No, wait. It was 3 tablets of this and a handful of capsules of that… This happened about 2 hours ago. Actually, I think it was last night.” Round and round the merry-go-round we go.

How should we risk-assess whether acetaminophen is involved?
If the patient provides no history of acetaminophen ingestion, do we need to order a level?

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2016-11-11T19:02:49-08:00Sep 4, 2013|Expert Peer Reviewed (Clinical), Tox & Medications|

Introducing Open, Post-Publication, Expert Peer Review on ALiEM

Today, we are busting open the concept of peer review for publications on blogs!

The peer review process has been criticized for its flaws, but is universally accepted as a necessary part of the scientific process. Peer reviewing allows experts in a field to determine the validity of a study or an article so that those of us who are less expert can reap the benefits of their knowledge. Until recently this process was almost universally pre-publication and anonymous. Authors would go through months of review and revision based on feedback of experts whose name they didn’t even know. In the last decade journals such as BMJ Open moved to an open peer review process by divulging the reviewer’s identities to the author and publishing the reviews of the experts online for open access to all readers. This open peer review model prevents redundancy and encourages transparency in the scientific process.

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By Natalie Desouza, MD|2016-11-11T19:03:36-08:00Sep 3, 2013|Expert Peer Reviewed (Clinical), Social Media & Tech|

Alcohol Problems Among Older Adults in the ED

The complications of alcohol use can be subtle in older adults, and the effects of alcohol are often incorrectly attributed to aging. Because of its under-recognition, the barriers to screening, and the many subtle ways in which it can present, some have suggested that alcohol misuse has replaced syphilis as the “great masquerader”. If you don’t think alcohol misuse is a problem among older adults in your ED, it may be because it has been hidden in plain sight.

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By Christina Shenvi, MD, PhD, MBA|2026-06-16T16:04:07-07:00Sep 2, 2013|Geriatrics, Tox & Medications|

Simulation Trick of the Trade: Blindfold the Leader

Simulations are routine now in medical training. But sometimes routine can start to get boring! All learners now know, especially for high fidelity simulations, to prepare for the unexpected. The stable patient will inevitably crash, maybe when your back is turned; the confederate in the room may or may not be a friend or a foe, you may never know! But these twists have become so integral to the simulation case that most learners know how to deal with it, or at the least know to anticipate it. But here is an idea for adding a new challenge to a stale simulation case. Blindfold the leader!

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By Nikita Joshi, MD|2016-11-11T19:03:25-08:00Aug 31, 2013|Medical Education, Simulation, Tricks of the Trade|