Patwari Academy videos: The Crashing Neonate

By |Categories: Patwari Videos, Pediatrics|Tags: |

In this series of videos, Dr. Rahul Patwari reviews the approach to the crashing neonate. Because these cases are often stressful, it is paramount to keep in mind a broad list of potential causes, such as “THE MISFITS” mnemonic: T rauma/abuse H eart disease E ndocrine (CAH, hyperthyroid) M etabolic (hypoglycemia, hyponatremia) I nborn errors S epsis F ormula mishaps I ntestinal catastrophes T oxins (home remedies) S eizures [+]

  • Reciprocal Change in aVL

The Importance of Reciprocal Changes in Lead aVL

By |Categories: Cardiovascular, ECG|

ECG interpretation is one of the most important skills to master as an emergency  physician, and its interpretation can be very complex and frustrating. ECG manifestations can be very subtle, and sometimes the earliest and only ECG change seen will be reciprocal changes alone. To further complicate this, many patients have the atypical symptoms of nausea/vomiting, weakness, or shortness of breath and not chest pain. [+]

  • Calcium Gluconate Calcium Chloride

Mythbuster: Calcium Gluconate Raises Serum Calcium as Quickly as Calcium Chloride

By |Categories: Tox & Medications|

LET’S START WITH THE FACTS We know that calcium chloride (CaCl2) provides 3 times more elemental calcium than an equivalent amount of calcium gluconate. So, CaCl2 1 gm = calcium gluconate 3 gm. CLINICAL QUESTIONS Does CaCl2 have better bioavailability than calcium gluconate? Does calcium gluconate have a slower onset of action because it needs hepatic metabolism to release the calcium? [+]

  • Lactate chemistry

Geriatric Blunt Trauma – Respect the Lactate

By |Categories: Geriatrics, Trauma|

Which is a better prognostic tool in geriatric trauma, traditional vital signs or lactate level? Meet Norma Nuance (NN), a 70-year-old woman with CAD, HTN, HLD, DM, and mild dementia. She was involved in an MVC as the restrained driver with questionable LOC. She arrives in your ED and appears confused, but has a history of dementia. There are no family members to tell you her baseline. Her BP is 120/80, and her HR is 90. She is not calling out in pain, but does mumble about her left arm when you ask if she is hurting. You think she [+]

Welcome new series Geriatric EM by Dr. Christina Shenvi

By |Categories: Geriatrics|

Welcome a new superstar blogger, Dr. Christina Shenvi (@clshenvi), to the ALiEM team. If there’s one talent I have, it’s spotting the rising academic star. As the new Geriatrics EM fellow at the University of North Carolina, she’ll be starting her monthly series of blog posts on Geriatric EM. I jumped at the chance when she came up with the idea of this series, since there is never enough teaching about the unique aspects in the emergent care of older patients. Since meeting her in March 2013 at the annual CORD meeting, it’s been the longest 4 months anxiously waiting [+]

  • platelet aggregation

Patwari Academy videos: Anticoagulation and reversal agents

By |Categories: Heme-Oncology, Patwari Videos, Tox & Medications|Tags: |

Bleeding in general is bad. Bleeding while on anticoagulants is VERY bad. Dr. Rahul Patwari reviews the pathophysiology of coagulation, the various reversal agents, and treatment approaches we can use. In this five-part series where all videos are less than 10 minutes, Rahul goes from the basic physiology of coagulation all the way to the complex reasoning and approaches to reversing anticoagulants. These are worth a quick look and review. [+]

  • Peanut Allergy Bracelet

The Dirty Epi Drip: IV Epinephrine When You Need It

By |Categories: Allergy-Immunology, Tox & Medications, Tricks of the Trade|

You’re a recent graduate picking up an extra shift in a small ED somewhere north of here. At 3 AM an obese 47 year-old woman presents with shortness of breath and difficulty speaking after eating a Snickers bar an hour earlier. She admits to history of hypertension, peanut allergy, and a prior intubation for a similar presentation. She is becoming more obtunded in the resuscitation room as you are collecting your history. A glance at the monitor shows: HR 130 BP 68/40 O2 saturation 89% on room air [+]

  • Brugada Syndrome

Brugada Syndrome: An ECG Pattern You Need to Know

By |Categories: Cardiovascular, ECG|

Brugada Syndrome is an abnormal ECG (Right Bundle Branch Block Pattern with coved ST elevation over the right precordial leads of V1-V3), which leads to ventricular fibrillation (VF) and sudden cardiac death (SCD) in patients with structurally normal hearts. It has been recognized as a clinical entity since 1992. Why should all ED physicians know about this entity? Although a rare syndrome, it is often mistaken as a STEMI and more importantly the clinical spectrum can be asymptomatic to SCD. [+]

Trick of the Trade: Got a shoulder dislocation? Park it

By |Categories: Orthopedic, Tricks of the Trade|Tags: , |

Myriad techniques exist to reduce shoulder dislocations, which includes scapular rotation, Hennepin, Snowbird, Cunningham, and Legg maneuvers. They are nicely reviewed at ShoulderDoc.co.uk. You can also supplement any technique with ultrasound-guided intraarticular lidocaine for improved pain control. Recently, Dr. Jay Park (Beth Israel Medical Center in New York) contacted me about his novel approach to shoulder reduction which anatomically makes sense. If his animation video doesn’t convince you, check out the video of an actual reduction. [+]

  • Anterior Shoulder Dislocation

Anterior Shoulder Dislocation: Are Prereduction Films Needed?

By |Categories: Orthopedic, Radiology|

A patient comes into your department with an obvious shoulder dislocation. You know you can easily reduce the shoulder and have the patient discharged before the orthopedic consultant calls back. But what if there is a fracture? Do you need to get that plain film before popping it back into place? [+]

Shuhan He, MD
ALiEM Senior Systems Engineer;
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Shuhan He, MD