PV Card: Electrolytes and ECG changes

By |Categories: ALiEM Cards, ECG, Endocrine-Metabolic|

The electrocardiogram can pick up all sorts of electrolyte abnormalities. The most common abnormalities revolve around high and low levels of potassium and calcium. Magnesium derangements typically have nonspecific findings. How do you keep things straight? To make things more complicated, multiple electrolyte derangements can occur at the same time, making ECG interpretation challenging. [+]

  • No Dumping

Paucis Verbis: EMTALA rules in the transfer of ED patients

By |Categories: Administrative, ALiEM Cards|

In U.S. academic emergency departments, decisions to accept patients is typically easy, because you have ready access to on-call physicians. When in doubt, accept transfer patients and sort things out later. What are the obligations for those transferring patients to other EDs? What do the EMTALA (a.k.a. "anti-dumping") rules say? When can you transfer unstable patients? As a general rule, the liability falls upon the transferring site and physician. So be sure that your patient won't decompensate in the ambulance during transfer. So, don't transfer that CP patient who is getting ruled-out for an MI or ACS no matter how good [+]

  • Hydrofluoric Acid burn

Tricks of the Trade: Calcium gel for hydrofluoric acid burns

By |Categories: Tox & Medications, Trauma, Tricks of the Trade|

A 41 y/o m presents to your ED after an occupational exposure to 30% hydrofluoric acid (HF). The thumb and index finger of his right hand were affected. Upon visual examination, the site of exposure looks relatively benign but the patient is complaining of extreme pain. Beyond giving opioids, what can you do? [+]

  • Mayo

Trick of the Trade: Pass the mayo – getting off black tar

By |Categories: Tricks of the Trade|

Industrial accidents sometimes involve hot coal tar stuck to a patient’s skin. Coal tar is notoriously challenging to remove once it has cooled and adhered to the skin. The tradition teaching is to apply large quantities of petroleum jelly to the black tar, let it sit for at least 60 minutes, and then diligently try to rub away the tar. Repeat as needed. What if you don’t have any petroleum jelly or petroleum-based products? [+]

  • ETT Lubricate

Paucis Verbis: Delayed sequence intubation

By |Categories: ALiEM Cards, Critical Care/ Resus|Tags: |

A 40-year-old man presents with significant agitation and severe respiratory distress from a COPD exacerbation. His oxygen saturation is 75% on room air, and he has diffuse, tight wheezes on exam. You prepare to intubate the patient using a rapid sequence induction protocol: etomidate, succinylcholine, 8-0 endotracheal tube. Or do you? This pocket card discusses the delayed sequence intubation (DSI) protocol made famous by Dr. Scott Weingart and Dr. Rich Levitan.1 Thanks to Dr. Michelle Reina (EM resident at Univ of Utah) and Dr. Rob (Intermountain Medical Center in Utah) for designing this helpful card. Rob has even implemented a DSI protocol in [+]

  • Oxycodone

Trick of the Trade: Oral naloxone for opioid-induced constipation

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

Opioids are amazingly effective for pain control. Patients on chronic opioids, however, often struggle with constipation. These patients may fail supportive treatment with enemas and laxatives. [+]

Shuhan He, MD

Shuhan He, MD

ALiEM Senior Systems Engineer;
Director of Growth, Strategic Alliance Initiative, Center for Innovation and [+]
  • Opioid structures

Peeing into the wind? Urine drug screens, part 2 (opiates)

By |Categories: Tox & Medications|

Apart from benzodiazepines, the opiate urine drug screens (UDS) are probably the most frequently utilized and misunderstood. [+]

Shuhan He, MD

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

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