The 4 T’s of Postpartum Hemorrhage

A 28-year-old G4P3 at 41 weeks presents to the ED via EMS. She is in active labor. On exam, a neonatal head is visible. Two minutes later, you deliver a healthy vigorous baby boy and hand him to your colleague. You notice persistent bleeding from her vaginal canal. Her tachycardia climbs to 110 bpm and her latest blood pressure is 78/48 mm Hg. We review postpartum hemorrhage (PPH) and the 4 T’s – a memory aid to help ED providers manage this life-threatening presentation.

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By Sarah Sanders, MD|2026-06-16T16:14:13-07:00Feb 6, 2019|Critical Care/ Resus, Ob/Gyn|

ALiEM AIR Non-ACS Cardiovascular Module

Welcome to the Non-ACS Cardiovascular 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 non-acs cardiovascular emergencies. 5 blog posts within the past 12 months (as of September 2018) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 2 AIR and 3 Honorable Mentions. We recommend programs give 2.5 hours (about 30 minutes per article) of III credit for this module.

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By Chris Belcher, MD|2020-09-04T11:13:21-07:00Feb 4, 2019|ALiEMU, Approved Instructional Resources (AIR series), Cardiovascular|

IDEA Series: A Low-fidelity Simulation Workshop for Teaching Cricothyroidotomy

The Problem

Cricothyroidotomy is an emergency life-saving procedure that involves surgical placement of a tube through the cricothyroid membrane in order to establish a patent airway for oxygenation and ventilation. The indications for this procedure are when traditional means, such as orotracheal or nasotracheal intubation, are contraindicated or have failed during attempts to establish an emergency airway.^1,2 It is a critical skill for emergency physicians but the declining rate of this procedure has resulted in decreased exposure during training.^3,4

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By Samuel Garcia|2019-03-28T21:25:08-07:00Feb 3, 2019|Critical Care/ Resus, IDEA series|

Trick of the Trade: Bubble Study for Confirmation of Central Line Placement

The safe placement a central venous catheter (CVC) remains an important part of caring for critically ill patients.¹ Over 5 million CVCs are placed each year in the United States. It is crucial to confirm that the central line is placed in the correct position in order to rule out potential complications of the procedure (e.g. pneumothorax) and begin administration of life-saving medications. Post-procedure chest radiographs (CXR) are the standard of care for CVC placements above the diaphragm. However, the annual cost to the U.S. healthcare system for CXRs after CVC placement is estimated to be over $500 million.² Further, in a busy ED, the limited availability of portable radiography may pose a considerable time delay. Radiography may also be limited in resource‐poor and austere settings, particularly the prehospital and military environments. We review a faster, cheaper, and more accurate alternative for evaluating CVC placement: point of care ultrasound (POCUS).

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By Timothy Montrief, MD MPH|2019-01-31T13:41:52-08:00Jan 31, 2019|Critical Care/ Resus, Tricks of the Trade, Ultrasound|

Influenza Update: IDSA 2018 Guidelines Detailed Review

Symptomatic influenza A and B infections cause worldwide morbidity and mortality every year. Annual vaccination remains the greatest prophylactic measure, but the vaccine is not 100% effective due to mismatch between the circulating and vaccine virus strains. Although most individuals will recover from influenza without incident, some specific patient populations are at high risk for severe complications. The Infectious Disease Society of America (IDSA) recently updated their clinical practice guidelines.¹ We review these key updates, including recommendations on who to test, treat, and provide chemoprophylaxis.

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By Jenny Koehl, PharmD, BCPS|2026-06-16T16:14:08-07:00Jan 28, 2019|Guideline Review, Infectious Disease, Public Health|

Significance of a traumatic pneumothorax or hemothorax found only on CT imaging

A 32 year old woman arrives in your emergency department after being in a motor vehicle collision where she was the seat-belted driver. She undergoes chest CT imaging despite a negative chest x-ray because of her ongoing anterior chest wall diffuse tenderness. You discover a small 10% pneumothorax (PTX), but no other associated thoracic injuries. Should you place a tube thoracostomy (chest tube)? Should this patient be admitted to the hospital? A 2019 Annals of Emergency Medicine paper by the NEXUS Chest research group tackles these questions.¹

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By Michelle Lin, MD|2019-03-28T21:36:39-07:00Jan 23, 2019|Expert Peer Reviewed (Clinical), Radiology, Trauma|

ACMT Toxicology Visual Pearls: Abnormal Brain Imaging

An 85 year-old man presented with coma after ingestion of a household product. Two key axial views of his brain MRI are shown. Which of the following did he ingest?

Apple cider vinegar
Bleach
Drain cleaner
Ethylene glycol
Hydrogen peroxide

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By Laura Tormoehlen, MD, FACMT, FAAN|2019-11-12T19:05:15-08:00Jan 21, 2019|ACMT Visual Pearls, Tox & Medications|