Alarms from the ventilator: Troubleshooting high peak pressures

Airway management is one of the defining skills of an emergency physician, but our role in the care of intubated patients may continue long after endotracheal tube placement is confirmed. In mechanically ventilated patients, acute elevations in airways pressures can be triggered by both benign and life-threatening causes. When the ventilator alarms, do you know how to tell the difference? What is your approach in troubleshooting the potential problems?

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By Todd A. Seigel, MD|2019-04-06T00:36:46-07:00Jul 30, 2013|Critical Care/ Resus, Expert Peer Reviewed (Clinical)|

Critical Care Series by new ALiEM writer Dr. Todd Seigel

Welcome a new superstar blogger, Dr. Todd Seigel (@ToddSeigelMD), to the ever-growing ALiEM team. I first met Todd at the recent Society of Academic Emergency Medicine meeting. At that time, he was an already established clinician-scholar-educator at Brown University. He had already graduated from residency and was returning to fellowship training to get his board-certification in Critical Care Medicine. I’m thrilled that he is now at my home institution (UCSF) doing this fellowship, where I couldn’t resist recruiting him to join our all-star cast of blog authors. Today is the first of hopefully a long series of critical care/resuscitation topics that are practically relevant for all practicing emergency physicians.

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By Michelle Lin, MD|2016-11-11T19:02:41-08:00Jul 30, 2013|Critical Care/ Resus|

Quick clinical tip: Elson’s test for the finger

Injuries to the hand are fraught with multiple, concurrent injuries. Many injuries may have chronic debilitating complications, if not detected early. One such example is a finger laceration with a concurrent extensor tendon injury, causing delayed boutonniere deformity formation and limited function. Review the anatomy of the extensor tendon. View the video on how to perform the Elson’s test to detect a central slip tendon injury.

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By Michelle Lin, MD|2026-06-16T16:03:47-07:00Jul 29, 2013|Orthopedic|

Patwari Academy videos: ECG intervals and segments

Last week, the Patwari Academy videos covered ECG basics on rate, rhythm, and axis. Here is another set of three videos discussing ECG intervals and segments — specifically the PR interval, QRS interval, and ST segments. Again, this is a nice review on ECG concepts.

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By Michelle Lin, MD|2019-01-28T21:57:28-08:00Jul 28, 2013|ECG, Patwari Videos|

Acute Coronary Syndrome (ACS) in the Elderly

Acute coronary syndrome (ACS) is the number one cause of mortality in patients older than 65 years old. ¹ To complicate this fact further, they also present atypically with weakness, nausea/vomiting, fatigue, and shortness of breath. It has been shown that older adults who present to the emergency department (ED) with ACS and a chief complaint other than chest pain have worse outcomes:

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By Salim Rezaie, MD|2019-09-10T13:36:48-07:00Jul 25, 2013|Cardiovascular, Geriatrics|

Quick clinical tip: Ulnar collateral ligament injury

A common thumb injury is the “gamekeeper’s thumb or “skier’s thumb”, which involves an injury to the ulnar collateral ligament (UCL) of the first MCP joint. It is caused by forced abduction and hyperextension of the thumb, such as from a ski pole. But did you know that there are two branches of the ligament that you should test?

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By Michelle Lin, MD|2016-11-11T19:02:36-08:00Jul 24, 2013|Orthopedic|

Supraventricular Tachycardia (SVT) With Aberrancy Versus Ventricular Tachycardia (VT)

Differentiating between SVT with aberrancy and VT can be very difficult. It is crucial to be able to make this distinction as therapeutic decisions are anchored to this differentiation. Brugada et al prospectively analyzed 384 patients with VT and 170 patients with SVT with aberrant conduction to see if it was possible to come up with a simple criteria to help differentiate between the two with high sensitivity and specificity.

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By Salim Rezaie, MD|2019-09-10T13:36:56-07:00Jul 23, 2013|Cardiovascular, ECG, Expert Peer Reviewed (Clinical)|