2020 ACLS Guidelines on Medications for Toxicology-Related Conditions

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

The 2020 ACLS guidelines provide recommendations on the medication-specific management recommendations for toxicology [1]. Although the name of the guidelines emphasize they are ‘Advanced,’ these are still relatively basic toxicology recommendations and largely apply to patients in cardiac arrest or refractory shock. There are also our 2020 ACLS guideline summaries on vasopressor and non-vasopressor medications used during cardiac arrest and arrhythmia management. Benzodiazepines Flumazenil if NOT recommended in undifferentiated coma (COR3, LOE B-R) Cocaine Benzodiazepines, alpha blockers, calcium channel blockers, nitroglycerin, and/or morphine can be beneficial for hypertension, tachycardia, agitation, or chest discomfort (COR 2a, LOE B-NR) Pure beta-adrenergic blockers may [+]

2020 ACLS Guidelines on Medications for Management of Specific Arrhythmias

By |Categories: Cardiovascular, Critical Care/ Resus, EM Pharmacy Pearls, Tox & Medications|

The 2020 ACLS guidelines provide recommendations on the medication-specific management for arrhythmias including wide-complex tachycardia, regular narrow-complex tachycardia, atrial fibrillation/flutter, and bradycardia [1]. There are also our 2020 ACLS guideline summaries on vasopressor and non-vasopressor medications used during cardiac arrest and toxicology-related conditions. Wide-complex tachycardia (WCT) Wide-complex tachycardia Medication(s) Evidence Hemodynamically stable Adenosine COR 2b, LOE B-NR Amiodarone, procainamide, or sotalol COR 2b, LOE B-R NOTE: Verapamil is harmful COR 3, LOE B-NR Polymorphic VT with long QT (torsades de points) Magnesium COR 2b, LOE C-LD Polymorphic VT without long QT Lidocaine or amiodarone COR 2b, LOE C-LD Regular [+]

2020 ACLS Guidelines on Vasopressors and Non-Vasopressors During Cardiac Arrest

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

The 2020 ACLS Guidelines were published in October 2020 [1]. This first of 3 blog posts will focus on vasopressor and non-vasopressor medications during cardiac arrest. Part 2 will focus on specific arrhythmia management and Part 3 will focus on toxicologic interventions. Summary There were no major updates for vasopressors and non-vasopressors used during cardiac arrest. The American Heart Association (AHA) published Highlights of the 2020 Guidelines [PDF] as a clear and concise summary. Now that the AHA is releasing focused updates in the 5-year period between guidelines (like this one on lidocaine), fewer major changes likely will be needed when [+]

Social Medicine in the Emergency Department: Not all conditions can be treated with medicines

By |Categories: Beyond the Abstract, Emergency Medicine|Tags: |

On the day we met Jane, a woman in her 70’s with diabetes and mobility impairment, she was visiting an Emergency Department (ED) for the 50th time in the past year. Jane was experiencing homelessness and spent much of her day riding public transportation in her wheelchair. Bystanders, often concerned for her health after noticing she had an episode of incontinence, would call 911 after which Jane would be brought to the nearest ED. On the day Jane came to our ED, our multidisciplinary ED-based Social Medicine team was asked to help in her care. She was very thin, her [+]

  • cdc gonorrhea chlamydia doxycycline

Doxycycline vs Azithromycin: Think Twice About the 2020 CDC Guideline Update on Treatment of Gonorrhea and Chlamydia

By |Categories: Genitourinary, Infectious Disease|

When the new Centers for Disease Control and Prevention (CDC) recommendations1 regarding the treatment of uncomplicated gonorrhea (and indirectly chlamydia) debuted like a slice of antibiotic resistance doom, it felt like another “gift” had arrived from 2020. Intramuscular (IM) ceftriaxone dosing has increased from 250 mg to 500 mg (or 1 g for weight ≥150 kg). Empiric chlamydia coverage switched from a single dose of 1 g of azithromycin to doxycycline 100 mg PO BID for 7 days. Being deferential to CDC expertise, many providers accepted them uncritically. Compliance rates with a switch from a 1-time to a 7-day regimen are not [+]

Free eBook Announcement: Emergency Medicine Resident Simulation Curriculum for Pediatrics (EM ReSCu Peds)

By |Categories: Pediatrics, Simulation|Tags: |

  The Emergency Medicine Resident Simulation Curriculum for Pediatrics (EM ReSCu Peds) is here! This free ebook contains 16 EM resident-tested, peer reviewed cases covering essential pediatric content identified through a robust modified Delphi process [1] with experts across the United States. Each chapter contains robust supporting materials to help educators prepare, execute, and debrief cases with residents at every level to help supplement the clinical experience. Download the EM ReSCu Peds eBook We request some basic demographic about you and how you plan to use the educational cases in the download form to provide us with necessary insights whether [+]

SAEM Clinical Image Series: What Lies Beneath?

By |Categories: Academic, Infectious Disease, SAEM Clinical Images, Ultrasound|

A 35-year-old male with a history of diabetes and pericarditis, status post pericardiectomy 3 years ago, presented with a painful lesion on his anterior chest wall. One month prior, the patient reported a bump at his sternotomy scar base which extruded a piece of suture when squeezed and subsequently healed. Two days ago, the patient developed diffuse right-sided chest pain. During the past 24 hours, an enlarging, erythematous, painful, non-draining lesion developed at the base of his scar. He reports subjective fever. He denies shortness of breath, exertional chest pain, nausea, and vomiting. [+]

SAEM Clinical Image Series: Left Ear Mass

By |Categories: Academic, ENT, Infectious Disease, SAEM Clinical Images|

A 25-year-old male who was previously healthy presents to the emergency department with a painful left posterior ear mass. The mass began as a “pimple” and has been increasing in size for the last 6 months. He has an associated headache, dizziness, and malaise. He denies fever, trauma, drainage, known insect bite, dysphagia, dyspnea, trismus, and hearing loss. He emigrated to the United States from Honduras 8 months ago. He was seen in the emergency department 4 months prior for a similar complaint, which was diagnosed as lymphadenopathy by point-of-care ultrasound. [+]

  • Calcaneus Fracture

SplintER Series: We’ve Got A Jumper

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

A 42-year-old patient is brought in by EMS after jumping off of a two-story building. The primary survey is intact and the secondary survey demonstrates swelling, ecchymosis, and tenderness to the right heel. You obtain foot x-rays and see the following images (Image 1. Lateral view of the right foot. Author’s own images).   [+]