SAEM Clinical Image Series: Chest Wall Mass

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 Harry Stark MD, MBS|2019-11-06T17:57:56-08:00Nov 7, 2019|Pulmonary, SAEM Clinical Images|

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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By Rosy Hao, MD|2019-09-05T17:59:37-07:00Aug 23, 2019|Dermatology, ENT, Pediatrics, PEM Pearls, Pulmonary, Tox & Medications|

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

ECMO for ARDS: Key Pearls for Emergency Physicians from the EOLIA Trial

The role of extracorporeal membrane oxygenation (ECMO) in the management of acute respiratory distress syndrome (ARDS) has been a source of debate within the critical care community.¹ The use of ECMO has steadily increased over the past decade;² however, evidence to support the widespread adoption of this expensive and invasive technology is limited. As advances in ECMO technology have rapidly outpaced evidence, clinicians have been left to speculate as to ECMO’s true value. Is ECMO a promising tool to advance the care of patients with respiratory failure³ or an expensive distraction that has inappropriately supplanted evidence-based strategies?⁴

All who care for patients with ARDS have been eagerly awaiting the results of the Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome (EOLIA) trial which were recently published in May 2018’s New England Journal of Medicine.⁵

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By Mac Walter, MD|2018-05-31T07:46:14-07:00May 31, 2018|Critical Care/ Resus, Pulmonary|

Renal Colic & Pulmonary Embolism CT | Reducing Imaging: ACEP E-QUAL Network Podcast

Computed tomography (CT) is increasingly available across U.S. Emergency Departments and has changed the practice of medicine. However, it is coupled with potential side-effects from radiation and contrast media. Emergency Medicine is beginning to make a concerted effort to identify clinical scenarios in which CT may be unnecessary, producing outcomes research and validated clinical decision rules. Renal colic and pulmonary embolism, in particular, seem amenable to this area of investigation. The ACEP E-QUAL Network podcast, a partnership with ALiEM to promote clinical practice improvements, reviewed this topic with experts Dr. Chris Moore (Emory University) and Dr. Jeffrey Kline (Indiana University). We present highlights from their discussion with Dr. Jason Woods.

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By Derek Monette, MD|2020-04-20T19:38:20-07:00Mar 5, 2018|Genitourinary, Podcasts, Pulmonary, Radiology|

Troubleshooting the Crashing Patient with a Tracheostomy

Patients presenting to the ED with respiratory distress and a tracheostomy can unnerve almost any provider, and management is often fraught with preventable errors.^1,2 This recognition has led to the development of treatment algorithms from groups including the U.K. National Tracheostomy Safety Project to improve the safety and quality of care for patients with tracheostomies.³ Use the ABC-Ts mnemonic to help you perform a focused tracheostomy evaluation and troubleshoot in a stepwise, systematic manner while waiting for your ENT consultant to arrive.

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By Puja Gopal, MD|2019-02-19T18:38:06-08:00Jan 31, 2018|Critical Care/ Resus, Pulmonary|

ALiEMU Capsules Module 9: Hospital Acquired Pneumonia

We are proud to present CAPSULES Module 9: Hospital Acquired Pneumonia (HAP), now published on ALiEMU. Here is a summary of the key points from a stellar module by Drs. Jamie Rosini and Matt Stanton. When you’re finished, head over to the Capsules page for even more practical pharmacology for the EM provider.
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