• em pharm pearls glucose d50 rise

EM Pharm Pearls: Estimated rise in blood glucose concentration with dextrose administration

By |Categories: EM Pharmacy Pearls, Endocrine-Metabolic|

A common question is how much should we expect the blood glucose concentration to increase after dextrose 50% (D50) administration. Fortunately, there is an answer from 3 studies. Balentine JR, Gaeta TJ, Kessler D, Bagiella E, Lee T. Effect of 50 milliliters of 50% dextrose in water administration on the blood sugar of euglycemic volunteers. Acad Emerg Med. 1998;5(7):691-694. doi:10.1111/j.1553-2712.1998.tb02487.x PMID 9678393 Population: Healthy volunteers in the ED Intervention: 25 gm (1 ampule of D50) Result: Mean increase of 162 mg/dL at 5 min. Glucose concentrations returned to baseline by 30 minutes. Murthy MS, Duby JJ, Parker PL, Durbin-Johnson BP, [+]

Trick of the Trade: A “Fiberbougie” through a supraglottic airway device (King tube)

By |Categories: Critical Care/ Resus, Tricks of the Trade|Tags: |

Resuscitation before intubation is a critical construct in modern emergency medicine. The prevention of peri-intubation arrest by correcting pre-intubation hypoxia, hypotension, and acidosis is often easier said than done. Worse yet, the intubation process itself, especially if difficult, can worsen hypoxia and hypotension which is often unrecoverable [1, 2] Supraglottic devices, such as a King Airway or laryngeal mask airway, can be placed quickly, and they effectively oxygenate and ventilate patients with a high degree of success [3]. Unfortunately, when the King (or similar device) is exchanged for an endotracheal tube, success is far from guaranteed. Ideally the King could [+]

  • mallet finger

SplintER Series: Stop! Hammer Time

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

A 54-year-old female presents to the emergency department with 3rd and 4th right finger pain after “jamming” them a week ago. She was reaching to tap someone on the shoulder and they backed into her hand forcing her fingers into flexion. She has swelling and pain at the distal interphalangeal (DIP) joint of her 3rd and 4th digits on the right and cannot extend the digits at the DIP joint. An x-ray of the right hand was obtained and is shown above (Figure 1: Lateral radiographs of the right hand. Author’s own images). [+]

ALiEM AIR Series | Non-ACS Cardiology 2022 Module

By |Categories: Approved Instructional Resources (AIR series)|

Welcome to the AIR non-ACS cardiology 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 non-ACS cardiology emergencies in the Emergency Department. 12 blog posts met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 5 AIR and 7 Honorable Mentions. We recommend programs give 6 hours (about 30 minutes per article) of III credit for this module. AIR Stamp of Approval and Honorable Mentions In an effort to [+]

Trick of the Trade: Don’t fight the ultrasound cord for peripheral IV access

By |Categories: Tricks of the Trade, Ultrasound|

Ultrasound-guided IVs require hand-eye coordination and fine movements of probe in Goldilocks fashion. Apply too much pressure, and the vein in question is compressed. Slide a little to the right, and now it's out of the window. Something that practitioners don't think about is the tension from the cord. If left to its own devices, the cord will tug on the probe, making the probe harder to steer and handle, especially for those tiny veins. Trick of the Trade: Reduce cord tension Have the patient grasp the cord! This makes them an active participant. Usually, if they are awake and [+]

PEM POCUS Series: Pediatric Appendicitis

By |Categories: Pediatrics, PEM POCUS, Ultrasound|

Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric appendicitis. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit. Take the ALiEMU PEM POCUS: Pediatric Appendicitis Quiz Module Goals Describe the indications for performing point-of-care ultrasound (POCUS) for appendicitis Describe the technique for performing POCUS for appendicitis Recognize anatomical landmarks for POCUS for appendicitis Interpret signs of appendicitis on POCUS List the limitations of POCUS for appendicitis Case Introduction: Child with thigh pain Mason is an 8-year-old [+]

  • Middle finger swelling and erythema

SplintER Series: Point Tender

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|Tags: , , |

  A 42-year-old female presents to the emergency department with complaints of worsening finger pain. She reports the pain started 2 days ago with redness at the tip of the finger. Over the past 24 hours, her redness has spread and the finger has become more painful. On arrival, she is afebrile and hemodynamically stable. She has the below exam findings with tenderness along the volar aspect of the finger and pain with passive extension (Figure 1). What is your suspected diagnosis? What is your initial workup? What is your management and disposition?   [+]

  • Lateral x-ray of the knee showing myositis ossificans

SplintER Series: Between a Rock and a Hard Place

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|Tags: , , |

  A 17-year-old male basketball player presents with right lateral thigh pain for the past 3 weeks. He had a collision with another player 5 weeks ago that resulted in a bruise that has since resolved. He is mildly tender over the lateral mid-thigh in the soft tissues and has a decreased knee flexion. You obtain X-rays (Figure 1). What is your suspected diagnosis? What is your initial workup in the ED? What imaging confirms the diagnosis? What is your management and disposition?   Figure 1: AP and lateral radiographs of the right femur [+]