PEM Pearls: Chest Radiographs for Shortness of Breath

chest radiograph

Figure 1: Photo by Tim Bish on Unsplash

Paramedics bring in a 5-month-old boy in respiratory distress. He’s crying furiously and has normal tone and color. Thick, copious secretions are coming from his nose. He is tachypneic with diffuse wheezes, crackles, retractions, and nasal flaring. His respiratory rate is 70 and his oxygen saturation is 88% on room air. Would you order a chest radiograph (CXR) for this child?

CXRs are routinely obtained in adults with respiratory symptoms. Children, however, are more sensitive to radiation and can have multiple respiratory infections every year. CXRs can increase cost, length of stay, and may not always be necessary.

This post presents some guidelines on when (and when not) to get a CXR in pediatric patients.

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By |2020-05-02T11:46:09-07:00May 27, 2020|PEM Pearls, Pulmonary, Radiology|

ALiEM AIR | Respiratory 2019 Module

Welcome to the AIR Respiratory Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to respiratory emergencies. 8 blog posts within the past 12 months (as of November 2019) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 2 AIR and 6 Honorable Mentions. We recommend programs give 4 hours (about 30 minutes per article) of III credit for this module.

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SAEM Clinical Image Series: Chest Wall Mass

Under skin lung herniation

A 71 year-old patient with a past medical history of hypertension, percutaneous transluminal coronary angioplasty 7 years ago, and robotic coronary artery bypass grafting of the left internal mammary artery to the left anterior descending artery 9 years ago presents with worsening dyspnea on exertion. He had a biopsy of the upper lobe of the left lung the week before. He was having a neoplastic mass evaluated. The patient presents with a soft left-sided anterior chest mass, inflating and deflating with respiration.

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By |2019-11-06T17:57:56-08:00Nov 7, 2019|Pulmonary, SAEM Clinical Images|

PEM Pearls: 5 Tips to Demystify Amoxicillin in Pediatric Infections

Amoxicillin is a penicillin derivative antibiotic against susceptible gram positive and gram negative bacteria. It has reasonable coverage for most upper respiratory infections and is used as prophylaxis for asplenia and bacterial endocarditis. This post aims to demystify amoxicillin treatment for common pediatric infections.

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SAEM Clinical Image Series: Dysphagia and Dyspnea in a Well Digger

progressive pulmonary fibrosis causing dysphagia and dyspnea

[Click for larger view]

Chief Complaint: Pain with swallowing

History of Present Illness: A 43-year-old male presented to the emergency department with progressing pain upon swallowing. He described a sensation of food becoming stuck and creating a fullness in his chest. Review of symptoms was positive for dyspnea on exertion worsening over several months, but negative for cough, fevers, or weight change. He reported no medical history and had recently emigrated from Guatemala where he worked as a well digger.
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By |2019-07-28T21:32:47-07:00Jun 17, 2019|Pulmonary, SAEM Clinical Images|

End-Tidal CO2 in Cardiopulmonary Resuscitation

Capnography in CPR

End-tidal CO2 (EtCO2) monitoring is a measure of metabolism, perfusion, and ventilation. In the ED, we typically think of a EtCO2 as a marker of perfusion and ventilation. However, EtCO2 is an extremely powerful surrogate for endotracheal tube (ETT) Position, CPR Quality, Return of spontaneous circulation (ROSC), Strategies for treatment, and Termination (of CPR). Do these letters look familiar? They should! In this post we take a deep dive into each of these potential uses of EtCO2 in the ED.

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By |2019-02-19T18:37:10-08:00Feb 6, 2019|Critical Care/ Resus, Pulmonary|

ALiEM Cards: Acute Respiratory Distress Syndrome – Berlin Definition

Berlin Definition of ARDSAcute respiratory distress syndrome (ARDS) is a complex, life-threatening form of respiratory failure. It is responsible for almost 75,000 annual deaths in the United States.1Management remains lung-protective mechanical ventilation, an intervention that can begin in the ED. The Berlin Definition of ARDS has better predictive validity for mortality in comparison to previous definitions of ARDS.2 ALiEM Cards: ARDS, written by Dr. Michelle Lin, reviews the Berlin Definition and provides EPs with an on-shift resource to help manage critically-ill patients.
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By |2018-06-21T11:40:11-07:00Jun 22, 2018|ALiEM Cards, Critical Care/ Resus, Pulmonary|
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