Hyperkalemia Management: Preventing Hypoglycemia From Insulin

Insulin remains one of the cornerstones of early severe hyperkalemia management. Insulin works via a complex process to temporarily shift potassium intracellularly. Though insulin certainly lowers plasma potassium concentrations, we often underestimate the hypoglycemic potential of a 10 unit IV insulin dose in this setting. The purpose of this post is to highlight the need for proper supplemental glucose and blood glucose monitoring when treating hyperkalemia with insulin.

This is such an important medication safety issue, the Institute for Safe Medication Practices (ISMP) highlighted it in a February 2018 Safety Alert.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2019-07-08T03:22:24-07:00Apr 22, 2015|Endocrine-Metabolic, Expert Peer Reviewed (Clinical)|

Trick of the Trade: TRUST ultrasound confirmation of pediatric endotracheal tube placement

Following intubation the confirmation of endotracheal tube placement and depth is essential. While dynamic etCO2 monitoring has revolutionized the confirmation of endotracheal placement, there are still several circumstances in which this modality may be misleading (e.g. prolonged arrest, severe status asthmaticus/PE/pulmonary edema, etCO2 detector contamination with drugs/gastric contents). Additionally, EtCO2 detectors cannot confirm appropriate endotracheal tube depth, leading to delayed recognition of mainstem placement.

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By Mark Tessaro, MD|2021-01-05T14:02:20-08:00Apr 21, 2015|Pediatrics, Ultrasound|

Diagnose on Sight: Lip Swelling

Case: A 24 year old male presents with right sided lip swelling that began several hours ago. This is the second time he has had this type of swelling. His mother has also had this before. He currently has no urticaria, dyspnea, wheezing, or stridor. What is the cause of this patient’s symptoms?

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By Jeff Riddell, MD|2016-12-22T18:46:48-08:00Apr 20, 2015|Allergy-Immunology, Diagnose on Sight|

A cost-effective, two-layer wound closure task trainer

Performing a two layer wound closure can be a challenging procedure in the Emergency Department for clinicians with limited wound care experience. Challenges include suture choice, suture placement, and the technique of burying the knot in the deep layer of the wound, and the availability of ready ‘volunteers’ with complex wounds willing to let novices practice on them. Commercially available suture models are expensive, and can be cumbersome to store, and difficult to obtain in a timely manner to provide the learner with opportunities to practice prior to wound repair on a patient in the department.

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By Rob Bryant MD|2016-12-19T11:02:01-08:00Apr 15, 2015|Expert Peer Reviewed (Clinical), Medical Education, Simulation, Trauma|

4 Pitfalls of Bedside Ultrasonography During First Trimester Pregnancy

One of the more common indications for the use of bedside ultrasound (US) is to evaluate patients who present to the emergency department (ED) with pain or bleeding during the first trimester of pregnancy. When performing this study, providers should be aware of several potential pitfalls that pose significant risk to both the patient and the provider.

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By Brian Bauerband, MD|2026-06-16T16:06:58-07:00Apr 13, 2015|Expert Peer Reviewed (Clinical), Ob/Gyn, Ultrasound|

PV Card: Acute Salicylate Toxicity

Patients with acute salicylate toxicity can rapidly decompensate and require clinicians to understand the pathophysiology of what is going on. First a respiratory alkalosis occurs with non-specific symptoms of vomiting and dizziness. Then an anion-gap metabolic acidosis also occurs with headache, tinnitus, and confusion. Below lists the core set of labs to obtain and treatment strategies by our stellar ALiEM-CORD Social Media and Digital Scholarship Fellow, Dr. Sam Shaikh.

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By Sam Shaikh, DO|2021-10-05T12:52:52-07:00Apr 8, 2015|Tox & Medications|

Ultrasound For The Win Case – 46F with Abdominal Pain #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 46-year-old woman presents with history of right-sided abdominal pain and vomiting.

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By Jeffrey Shih, MD, RDMS|2017-07-19T00:07:32-07:00Apr 6, 2015|Gastrointestinal, Ultrasound, Ultrasound for the Win|