ALiEM Cards: Maternal Cardiac Arrest

By |Categories: ALiEM Cards, Ob/Gyn|

Maternal cardiac arrest is a low-frequency, high-risk pregnancy complication with 2 lives at stake. Incidence is approximately 1 in 12,000 to 50,000 pregnancies with a greater than 40% mortality rate. Understanding physiologic changes of pregnancy and how to perform a perimortem cesarean section (resuscitative hysterotomy) are critical aspects of caring for maternal cardiac arrest. ALiEM Cards: Maternal Cardiac Arrest, written by Drs. Jeffrey Sakamoto, Collin Michels, Nikita Joshi, and Rebecca Bavolek, reviews the causes, management pearls, and summarizes the perimortem cesarean delivery. […]

ALiEMU AIR Peripheral Vascular Disease Module

By |Categories: ALiEMU, Approved Instructional Resources (AIR series), Cardiovascular|

Welcome to the Peripheral Vascular Disease (PVD) 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 PVD emergencies. 2 blog posts within the past 12 months (as of May 2018) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 0 AIR and 2 Honorable Mentions. We recommend programs give 1 hour (about 30 minutes per article) of III credit for this module. […]

Can’t Miss ECG Findings for the Emergency Medicine Provider

By |Categories: ECG|

Sudden cardiac death accounts for almost 400,000 deaths per year in the United States, and EM providers must be adept at discerning subtle, high-risk ECG findings. With the advent of triage ECG protocols, one of the most common interruptions in the ED is a request to “sign off” on an ECG. We present a reference of some of the most important high-risk ECG findings, intended to help ED providers systematically screen patients in triage and the waiting room. […]

SplintER Series: Common ED Splint Techniques 104

By |Categories: SplintER|

The SplintER series is back with its fourth installment! In this series, we review splinting fundamentals, introduce advanced concepts, and highlight ways to implement these into your next shift. In this post, we summarize some of the most commonly deployed splints in the ED. Peer-reviewed by sports medicine experts (Dr. Kori Hudson and Dr. Anna Waterbrook), these injury-splint summary tables provide information on the origin, insertion, and positioning for each splint, along with the recommended number of layers of plaster. […]

ALiEM Cards: Tumor Lysis Syndrome

By |Categories: ALiEM Cards, Critical Care/ Resus, Heme-Oncology|

Tumor lysis syndrome (TLS) is an oncologic emergency characterized by life-threatening metabolic disturbances. Although it is most frequently associated with the treatment of hematological malignancies, its frequency may be increasing among patients with solid tumors. Emergency providers should be familiar with the presentation and treatment of these electrolyte abnormalities, which can lead to renal failure, seizures, and cardiac dysrhythmias. ALiEM Cards: Tumor Lysis Syndrome, written by Drs. Christopher Nash and Derek Monette, reviews TLS and the latest updates in its management. […]

ALiEM Cards: Acute Respiratory Distress Syndrome – Berlin Definition

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

Acute 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. […]

ALiEM AIR Series: Endocrine Module

By |Categories: ALiEMU, Approved Instructional Resources (AIR series), Endocrine-Metabolic|

Welcome to the Endocrine 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 Endocrine emergencies. 8 blog posts within the past 12 months (as of May 2018) 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 3 hours (about 20 minutes per article) of III credit for this module. […]

PEM Practice Changing Paper: Clinical Trial of Fluid Infusion Rates for Pediatric DKA

By |Categories: Critical Care/ Resus, Endocrine-Metabolic, Neurology, Pediatrics|

Most protocols for managing pediatric patients with diabetic ketoacidosis (DKA) are based on a theoretical association between fluid resuscitation and subsequent neurological decline. Although the evidence for an association between IV fluids and cerebral edema comes from retrospective reviews, for over 20 years, it is an accepted teaching principle of pediatric DKA. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis, published just days ago in the New England Journal of Medicine, challenges this teaching with the first randomized controlled trial designed to investigate the relationship between IV fluids and cerebral edema. We review this publication and present a behind-the-scenes podcast interview [...]

The Myth of Vasopressors and Ischemia

By |Categories: Critical Care/ Resus, Tox & Medications|

Despite the widespread clinical use, and their well-documented life-saving properties, vasopressors are often maligned, accused of causing ischemia to fingers, toes, mesentery, kidneys, and so forth. Not only is the evidence that this happens poor, but, a fear of this dreaded complication can unwarrantedly lead good clinicians to limit or withhold potentially life- and organ-saving medications. This article showcases the importance of end-organ perfusion and explains how vasopressors may in fact be one of the most important therapies in an emergency physician’s armamentarium. […]