Evaluation and Management of Heat Stroke

Heat-related illnesses comprise a continuum of disorders ranging from the minor heat edema, heat rash, heat cramps, and heat exhaustion to the more life-threatening condition known as heat stroke. As a general rule, it is involves a process whereby heat gain overwhelms the body’s mechanisms of heat loss. Often it is caused by an impairment of the body’s cooling and adaptive mechanism to effectively transfer heat to the environment, thus leading to a rise in core temperature. ¹

(more…)

By Katherine Li|2016-11-11T19:39:56-08:00Oct 28, 2015|Environmental, Expert Peer Reviewed (Clinical)|

PV Card: Initial Pain Medication Options in the Emergency Department

The emergency department (ED) manages acute pain on a daily basis, ranging from non-traumatic back pain to traumatic fractures. Some providers jump immediately to opioids without considering other non-opioid alternatives or start at incorrect doses. In the age of the opioid epidemic (ALiEM-Annals of EM journal club; bookclub discussing Dreamland) and medication errors, choosing the initial right agent(s) and dose(s) are important. Dr. Nick Koch and Dr. Sergey Motov (@PainFreeED) from Maimonides Medical Center present a thoughtful, evidence-based PV reference card on selecting and dosing initial pain medications for ED patients. Also congratulations to Dr. Motov and his team for their recent 2015 Annals of EM publication¹ on subdissociative dose ketamine for analgesia.

(more…)

By Michelle Lin, MD|2021-10-04T09:52:20-07:00Oct 23, 2015|ALiEM Cards, Tox & Medications|

PV Card: Continuous End Tidal CO2 Monitoring in Cardiac Arrest

For many years, end tidal CO2 monitoring initially was helpful in differentiating tracheal versus esophageal intubations. Now with continuous end tidal capnography, providers have access to so much more information during a cardiac arrest resuscitation, as summarized by the recently released 2015 American Heart Association (AHA) recommendations.¹ Thanks to Dr. Abdullah Bakhsh from Emory University for a great PV card to help remind us of these key cardiac resuscitation pearls.

PV Card: Continuous End Tidal CO2 Monitoring in Cardiac Arrest

<span data-mce-type="bookmark" style="display: inline-block; width: 0px; overflow: hidden; line-height: 0;" class="mce_SELRES_start"></span>
Adapted from [1-4]

References

Link M, Berkow L, Kudenchuk P, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S444-64. [PubMed]
Ahrens T, Schallom L, Bettorf K, et al. End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest. Am J Crit Care. 2001;10(6):391-398. [PubMed]
Silvestri S, Ralls G, Krauss B, et al. The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system. Ann Emerg Med. 2005;45(5):497-503. [PubMed]
Kleinman M, Brennan E, Goldberger Z, et al. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S414-35. [PubMed]

By Michelle Lin, MD|2021-10-19T19:25:31-07:00Oct 20, 2015|ALiEM Cards, Cardiovascular, Critical Care/ Resus|

PV Card: Normal Values for Ultrasound Measurements

As emergency medicine providers become more proficient in using bedside ultrasonography as a diagnostic tool, it can be difficult to remember all of the normal cutoff values. Is it 3 or 5 mm as the cutoff? Thanks to the team at UCSF (Dr. Maria Beylin, Dr. Scott Fischette, and Dr. Nate Teismann) for creating a succinct PV card listing the key numbers to remember. You can download this PV card into your mobile device as a reference guide, or you can even print and attach to each of your ultrasound machines!

PV Card: Normal Values for Ultrasound Measurements

<span data-mce-type="bookmark" style="display: inline-block; width: 0px; overflow: hidden; line-height: 0;" class="mce_SELRES_start"></span>
Adapted from [1–4]

References

Horrow M. Ultrasound of the extrahepatic bile duct: issues of size. Ultrasound Q. 2010;26(2):67-74. [PubMed]
Beigel R, Cercek B, Luo H, Siegel R. Noninvasive evaluation of right atrial pressure. J Am Soc Echocardiogr. 2013;26(9):1033-1042. [PubMed]
Doubilet P, Benson C, Bourne T, et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 2013;369(15):1443-1451. [PubMed]
Adhikari S, Zeger W, Thom C, Fields J. Isolated Deep Venous Thrombosis: Implications for 2-Point Compression Ultrasonography of the Lower Extremity. Ann Emerg Med. 2015;66(3):262-266. [PubMed]

By Michelle Lin, MD|2021-10-04T09:56:16-07:00Oct 15, 2015|ALiEM Cards, Ultrasound|

Diagnose on Sight: Fifth Metatarsal Fractures

$fifth metatarsal fracture.jpg$ Case: A 24 year old male presents with foot pain after a fall down a set of stairs. He reports pain and swelling over the lateral surface of his foot and he has not ambulated due to the pain. Based on the X-ray, what is the diagnosis?

(more…)

By Jeff Riddell, MD|2026-06-16T16:08:03-07:00Oct 14, 2015|Diagnose on Sight, Orthopedic|

NEXUS Chest CT Decision Instruments in Blunt Trauma

One of the five 2014 American College of Surgeons’ Choosing Wisely recommendations is to avoid routing whole-body CT imaging of trauma patents, also known as the ‘pan-CT’. Until now, no validated decision instrument existed to help guide clinicians decide whether to obtain a chest CT in the setting of blunt trauma. This month, Dr. Robert Rodriguez and the multi-institutional NEXUS Chest CT research team published a paper describing the derivation and validation of 2 decision instruments in PLOS Medicine [1].

(more…)

By Michelle Lin, MD|2026-06-16T16:08:13-07:00Oct 13, 2015|Radiology, Trauma|

AIR Series: Cardiology – CHF, PVD, and Others (part 2)

As mentioned last module, the FOAMsphere contains a phenomenal amount of cardiology content. Accordingly, the CORD testing schedule and our cardiology module has been divided into two parts. Below we have listed our selection of the 12 highest quality blog posts within the past 12 months (as of August 2015) related to acute coronary syndromes, curated and approved for residency training by the AIR Series Board. In this module we have 6 AIRs and 6 Honorable Mentions. We strive for comprehensiveness by selecting from a broad spectrum of blogs from the top 50 listing per the Social Media Index.

(more…)

By Andrew Grock, MD|2017-03-05T14:14:16-08:00Oct 12, 2015|Approved Instructional Resources (AIR series), Cardiovascular|