Esmolol Use in Cardiac Arrest

There is an abundance of sympathetic stimulation in patients who present in ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) whether endogenously released as a stress response or exogenously administered in a resuscitation attempt.¹ The hope is that sympathetic stimulation will increase the coronary and cerebral perfusion pressure of the patient and aid in resuscitation. However, there are numerous detrimental effects associated with epinephrine such as an increase in myocardial oxygen demand leading to increased ischemia.²

Contrary to traditional teaching, interesting evidence exists in both animal models as well as in limited reports in human subjects that show a potential benefit with beta blockade in cardiac arrest.

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By Jill Logan, PharmD BCPS|2016-12-19T10:52:53-08:00Dec 11, 2014|Cardiovascular, Critical Care/ Resus|

The Training of an EM Pharmacist

At the 2014 American College of Emergency Physicians Scientific Assembly, ACEP passed Resolution 44, officially recognizing Emergency Medicine Pharmacists as valuable members of the EM team. Nadia Awad (@Nadia_EMPharmD) summarized the importance of the resolution’s passage on the EMPharmD blog. The role of an EM Pharmacist has been outlined by the American Society of Health-System Pharmacists (ASHP). In addition, Zlatan Coralic (@ZEDPharm), one of ALiEM’s regular contributors, framed the EM Pharmacist as the ‘ultimate consult service.’ The intent behind this post is not to discuss the role of the EM Pharmacist, but to highlight the rigorous training process through which most EM Pharmacists have traversed to work in this amazing specialty.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2026-06-16T16:06:34-07:00Dec 9, 2014|Academic, Tox & Medications|

ALiEM-Annals of EM Journal Club: Satisfaction Scores and ED Analgesic Medications

ALiEM-AnnalsEM-Square This ALiEM-Annals of EM Global Journal Club features the Annals of EM journal club by Schwartz et al. entitled “Lack of Association Between Press Ganey Emergency Department Patient Satisfaction Scores and Emergency Department Administration of Analgesic Medications.” We hope you will participate in an online discussion based on the clinical vignette and questions below from now until Dec 5 2014. Please respond by commenting below or tweeting using the hashtag #ALiEMJC. In a few months, a summary of this journal club will be published in Annals of EM.

On Dec 4, 2014 at 1300 PST (1600 EST), we will host a live Google Hangout with the authors Drs. Tayler Schwartz and Kavita Babu.

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By Justin Hensley, MD|2017-07-15T12:31:51-07:00Dec 1, 2014|Journal Club, Tox & Medications|

Trick of the Trade: Pediatric video laryngoscope for ear foreign bodies

It is near the end of your shift and one of the nurses asks you to see a fellow ED staff member’s nine-year old daughter who has accidentally put a foreign body into her ear. You go see her and the otoscope reveals a small shiny jewel within the ear canal however flushing does not work to get it out. Next you try using the otoscope, while exposing the ear canal and holding the forceps to grasp the object. Unfortunately, it is difficult to get your assistant to align the light, and the otoscope speculum is limited in view and access.

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By Yen Chow, MD CCFP|2016-11-11T19:35:39-08:00Nov 26, 2014|ENT, Tricks of the Trade|

Can Permanent Marker Leach into IV Infusion Bags?

You are resuscitating a hypotensive patient with severe sepsis and have just hung your 4th liter of crystalloid. On the fluid bags, you wrote the numbers 1 through 4 in permanent marker to help keep track of your resuscitation. As you finish placing your central line the charge nurse enters the room. He informs you that according to the Institute for Safe Medical Practices (ISMP), writing directly on IV bags with permanent marker is not recommended due to concerns that the ink will leach into the bag and potentially cause harm to your patient.^1–4

This situation raises several questions:

Should we write on IV bags in permanent marker?
Is there a possibility of ink diffusing through polyvinylchloride (PVC) bags?
If so, is there potential harm to the patient?

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By Jeremy Bair, PharmD, BCPS|2019-02-19T18:22:53-08:00Nov 24, 2014|Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical), Tox & Medications|

Ultrasound For The Win! Case – 93F with Chest Pain

Welcome to another ultrasound-based clinical 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 the management or aided in diagnoses. In this month’s case, a 93-year-old female presents to the Emergency Department with crushing chest pain.

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By Jeffrey Shih, MD, RDMS|2019-02-19T18:22:55-08:00Nov 20, 2014|Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical), Ultrasound, Ultrasound for the Win|

Why Henderson and Hasselbalch Belong in the ED

If you’re like me, you learned and then promptly forgot the Henderson Hasselbalch equation (HH eq) in medical school.¹ After all, in clinical rotations it was never invoked, and our patients seemed to have fared well without it. So why bring up the topic now?

Medicine is changing. The ubiquitous nature of computing allows a level of sophistication exponentially greater than before. To a large extent we’re freed from much of the onerous work of rote memorization. In the ideal, that should free us to be more thoughtful about the way we approach our work and to have a deeper understanding of health and disease. Going forward, medicine will become increasingly computational. With that in mind, I’ll make three points about the HH eq.

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By Frank Ruiz, MD|2016-11-28T17:27:51-08:00Nov 19, 2014|Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical)|