Calcium channel blockers for stable SVT: A first line agent over adenosine?

A 52-year old man presents via EMS with a chief complaint of “racing heartbeat” for one hour. He is placed on a cardiac monitor which shows a heart rate of 185, an ECG reveals supraventricular tachycardia (SVT), and his blood pressure is 143/95 mmHg. As you ask the nurse to procure 6 mg of adenosine, the patient’s eyes grow wide.

“Please doc…” he pleads, “anything but that! Last time they gave that to me I thought I was gonna die!”

You recently read about using calcium channel blockers (CCBs) for paroxysmal SVT (PSVT), but can’t recall the last time you actually considered using them. After all, it’s been over 20 years since we switched to using adenosine first-line.

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By Stephen Rappaport, PharmD, BCPS|2024-01-12T02:08:09-08:00Mar 23, 2016|Cardiovascular, Expert Peer Reviewed (Clinical), Tox & Medications|

AIR Series: Neurology Module 1 – Bleeds and Strokes

Welcome to the first 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 neurology content relating to intracranial hemorrhage and stokes. Below we have listed our selection of the 17 highest quality blog posts within the past 12 months (as of November 2015) related to neurologic emergencies, curated and approved for residency training by the AIR Series Board. More specifically in this module, we identified 5 AIRs and 12 Honorable Mentions.

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By Andrew Grock, MD|2018-10-28T21:25:18-07:00Mar 14, 2016|Approved Instructional Resources (AIR series), Neurology|

PEM Pearls: Pediatric Concussions

A 9-year boy was hit in the head during a soccer game and was out for a few seconds. He regained consciousness quickly, but was repetitive for EMS. By the time the patient arrived at the ED, he was back to his normal self. Did this patient sustain a concussion? If so, what discharge instructions, anticipatory guidance, and resources do you have for your patient and his family? Here’s a quick 170-second animated video tutorial to sum up some thing for you.

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By Delphine Huang, MD|2026-06-16T16:08:51-07:00Mar 7, 2016|Pediatrics, PEM Pearls, Trauma|

Fentanyl: Adding Fuel to the Fire in the North American Opioid Epidemic

Drug poisoning is now the leading cause of injury death in the United States,¹ with opioids accounting for up to 40% of these deaths. In the U.S., prescription opioid death rates have more than quadrupled since 1999, and death rates exceed those due to motor vehicle crashes.² Similar trends in opioid exposure and death rates in Canada suggest that it is not far behind. Prescriptions for opioid analgesics paralleled a rise in opioid abuse and fatalities between 2002 and 2010, leveling off between 2011 and 2013,³ only to rise again in 2014.⁴ Among the more frequently misused opioids nationwide are oxycodone and hydrocodone (the most widely prescribed drug in the U.S.) in their various formulations, and methadone, but a “rising star” in the epidemic in many regions is fentanyl.

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By Scott Lucyk, MD|2026-06-16T16:08:54-07:00Feb 29, 2016|Tox & Medications|

Trick of the Trade: Topical Tranexamic Acid Paste for Hemostasis

Tranexamic acid (TXA) can be used in a wide variety of settings in the Emergency Department for its hemostatic effects. Topical applications of TXA are commonly utilized to control minor bleeding from epistaxis, lacerations, or dental extractions.^1–3 More in-depth reviews of topical TXA can be found on R.E.B.E.L EM⁴ and The Skeptics Guide to Emergency Medicine.⁵

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By Scott Dietrich, PharmD|2021-05-13T09:40:48-07:00Feb 17, 2016|Heme-Oncology, Trauma, Tricks of the Trade|

Zika Virus: What emergency department providers need to know

The Zika virus outbreak has recently been put on “Level 1” activation status by the Emergency Operations Center at the U.S. Centers for Disease Control and Prevention (CDC). If you haven’t already thought about this affecting your emergency department, you should starting now. A Level 1 status has been triggered only 3 times in the recent years: Ebola (2014), H1N1 (2009), Hurricane Katrina (2005). The following are some key facts and resources.

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By Lauren Pike, MD|2026-06-16T16:09:00-07:00Feb 15, 2016|Expert Peer Reviewed (Clinical), Infectious Disease|

ALiEMU CAPSULES Module 5: Procedural Sedation & Analgesia in the ED

We are proud to present CAPSULES module 5: Procedural Sedation & Analgesia in the ED, now published on the Academic Life in EM University (ALiEMU) website. Here is a summary of the key points from this outstanding module by Dr. Zlatan Coralic and Dr. Nadia Awad.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2017-10-01T20:25:37-07:00Feb 10, 2016|Capsules, Tox & Medications|