They started at once, and went about among the Lotus-eaters, who did them no hurt, but gave them to eat of the lotus, which was so delicious that those who ate of it left off caring about home, and did not even want to go back and say what had happened to them, but were for staying and munching lotus with the Lotus-eaters without thinking further of their return.
— Odyssey IX, translated by Samuel Butler
One of the final common denominators dictating the success or failure of any resuscitative effort, be it a trauma or medical code, is the patient’s acid-base status. In the presence of acidosis, many of the tools at your disposal, including vasopressors, become impotent and the patient’s ability to strike a balance between bleeding and clotting or mounting an appropriate inflammatory response become deranged.1–6 So what are the options to tilt the acid-base status in our favor?
We are thrilled to announce the next installment of ALiEM CAPSULES: Pharmacology of Emergency Airway Management (part 1), which was just published to the ALiEMU site. This is the first part of a 2-part course focusing on the pharmacology of the emergency airway. For this CAPSULES module we are introducing a multimedia-enhanced learning experience. You will find HD videos throughout the module providing further educational content. Some of the quizzes are also accompanied by video cases followed by a question based on the case you just watched. If you cannot use audio on your device, no problem, all videos are closed captioned (just hit the CC button in the YouTube window). We hope these videos further enrich your ALiEMU CAPSULES educational experience and we welcome any suggestions or comments!
Welcome to the second bolus of 60-Second Soapbox! Each episode, one lucky individual gets exactly 1 whole minute to present their rant-of-choice to the world. Any topic is on the table – clinical, academic, economic, or whatever else may interest an EM-centric audience. We carefully remix your audio to add an extra splash of drama and excitement. Even more exciting, participants get to challenge 3 of their peers to stand on a soapbox of their own!
Case Presentation: A 37 y/o woman presents to the ED with altered mental status. The vital signs are within normal limits. The history is provided by a friend who states that the patient was normal 2 hours ago when they were together. When she returned home, she found the patient in this state next to an empty bottle of acetaminophen (APAP) and 5 empty beer cans. A recent loss in the family has led to some depression in the last few weeks. A battery of labs are sent off including a ‘tox panel’ consisting of serum EtOH, salicylate, and APAP levels. The presumed time of ingestion is 2 hours prior to presentation.
Every year, EM residents ponder whether to do a fellowship. In the ALiEM Chief Resident Incubator, a handful are very interested in a medical toxicology fellowship, but I woefully am unqualified to provide any advice. So in a “phone a friend” moment, I boldly sent out an email requesting advice and insights. I received two amazing replies from Dr. Lewis Nelson (NYU) from a fellowship director’s perspective and Dr. Annie Arens (UCSF) from a fellow’s perspective.
Our virtual school doors are open starting today to ALiEM University (ALiEMU), which can best be thought of as our open-access, on-demand, online school of e-courses for anyone practicing Emergency Medicine worldwide. This ambitious venture was made possible by a tremendous team, but primarily led by Chris Gaafary, MD (@CGaafary), ALiEMU’s Chief of Design and Development and an EM chief resident in his free time at the University of Tennessee. Today we are incredibly excited to launch our inaugural longitudinal e-course the ALiEM Capsules Series: A Practical Pharmacology for the EM Practitioner, created and led by Bryan Hayes, PharmD, FAACT (@PharmERToxGuy).
