Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) Trial

Currently, guidelines recommend therapeutic hypothermia for comatose adults with out-of-hospital cardiac arrest (OHCA). A recent trial of adults with OHCA showed that therapeutic hypothermia with the use of a targeted temperature of 33°C vs maintained therapeutic normothermia of 36°C, did not improve outcomes. There is a paucity of randomized trials of therapeutic hypothermia in children with OHCA, but sometimes adult trials get extrapolated to pediatrics. There are differences between adult and pediatric populations with OHCA, which makes it difficult to extrapolate the results of the adult trials to a pediatric population.

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By Salim Rezaie, MD|2016-12-19T11:45:33-08:00May 25, 2015|Critical Care/ Resus, Pediatrics|

Ultrasound For The Win! Case – 101M with Altered Mental Status #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 101-year-old man presents after being found down with altered mental status.

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By Jeffrey Shih, MD, RDMS|2017-07-19T00:07:20-07:00May 20, 2015|Cardiovascular, Expert Peer Reviewed (Clinical), Ultrasound, Ultrasound for the Win|

Ketamine for Excited Delirium Syndrome

Excited delirium syndrome is defined as “a syndrome of uncertain etiology characterized by delirium, agitation, and hyperadrenergic autonomic dysfunction”.¹ You may have encountered a patient like this in the ED or prehospital setting. Although the etiology is impossible to determine in many cases, stimulant abuse and other drugs are involved in a majority of cases. An 8% mortality has been ascribed to Excited Delirium Syndrome, resulting from hyperthermia, severe metabolic acidosis, and cardiovascular collapse.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2017-10-25T08:21:33-07:00May 18, 2015|Expert Peer Reviewed (Clinical), Neurology, Tox & Medications|

Trick of the Trade: IV-Push Antibiotics in the ED

Limited intravenous access is a common conundrum in the Emergency Department, with heavy implications for medication administration. Of particular concern, are the profoundly septic patients that necessitate multiple timely therapies, which require tying up a line – fluids, pressors, several antibiotics, etc. The shift away from less central line (i.e. triple lumen) placement for initial resuscitation, may serve to further exacerbate this issue.

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By Adam Spaulding, PharmD BCPS|2019-04-06T00:40:49-07:00May 11, 2015|Expert Peer Reviewed (Clinical), Tox & Medications|

Vancomycin Loading Doses in Pediatric Patients: A Missed Opportunity?

In January 2014, ALiEM featured a must-read post by Bryan Hayes regarding proper dosing of vancomycin in the emergency department, including a special note related to the recommendations regarding consideration of loading doses of vancomycin ranging from 25 to 30 mg/kg in adult patients who are critically ill with a high suspicion for MRSA infection.

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By Nadia Awad, PharmD, BCPS|2016-12-19T15:22:24-08:00May 4, 2015|Expert Peer Reviewed (Clinical), Pediatrics, Tox & Medications|

AIR Series: GU/Renal Module 2015

Welcome to the eighth ALiEM Approved Instructional Resources (AIR) Module! In an effort to reward our residents for the reading and learning they are already doing online we have created an Individual Interactive Instruction (III) opportunity utilizing FOAM resources for U.S. Emergency Medicine residents. For each module, the AIR board curates and scores a list of blogs and podcasts. A quiz is available to complete after each module to obtain residency conference credit. Once completed, your name and institution will be logged into our private database, which participating residency program directors can access to provide proof of completion.

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By Andrew Grock, MD|2026-06-16T16:07:17-07:00Apr 29, 2015|Approved Instructional Resources (AIR series), Genitourinary, Renal|

Four reasons not to order a Rapid Flu test

Every year emergency departments are inundated with cases of influenza-like illness. Rapid flu testing (RFT) offers the promise of a quick and relatively noninvasive rapid diagnostic test. However, the use of this test has significant limitations that can lead to increased risk for both the patient and the provider.

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By Matthew DeLaney, MD|2018-01-30T02:48:07-08:00Apr 27, 2015|Expert Peer Reviewed (Clinical), Infectious Disease|