Calcium before Diltiazem may reduce hypotension in rapid atrial dysrhythmias

By |Categories: Cardiovascular, Tox & Medications|

  The Case A 56 y/o man presents to the ED via ambulance. He was sent from clinic for ‘new onset afib.’ His pulse ranges between 130 and 175 bpm, while his blood pressure is holding steady at 106/58 mm Hg. He has a past medical history significant for hypertension and hypercholesterolemia. His only medications are hydrochlorothiazide and atorvastatin. The decision is made to administer an IV medication to ‘rate control’ the patient with a goal heart rate < 100 bpm. Calcium channel blockers, such as diltiazem and verapamil, can both cause hypotension. In the case above, the patient has [...]

ALiEM Sim Case Series: Pediatric WPW

By |Categories: Pediatrics, Simulation|Tags: |

Case Writer: Nikita Joshi, MD Keywords Pediatrics, Syncope, Wolff Parkinson White (WPW), PALS Educational Objectives Medical Discuss a broad differential diagnosis for pediatric syncopeIdentify critical findings in pediatric EKGManage WPW tachycardia Communication Obtain a focused history in a pt with WPW focusing upon family historyCommunicate as an interdisciplinary team Case Synopsis 10 yo boy BIBEMS s/p syncope. Pt was playing on the football field, running down field when he suddenly collapsed. Bystanders quickly went to the boy and within 1 minute the pt had regained consciousness without any intervention. When EMS arrived on the scene, the boy was sitting with [...]

Three predictors for success in cardiac arrest resuscitations

By |Categories: Cardiovascular|

The goal of resuscitation in cardiac arrest is to respond in a timely, effective manner that leads to good patient outcomes.  Resuscitation is not taking an ACLS and BLS course and going through the motions of a code. There have been several studies looking at the quality of intubation and CPR, and their association with good patient outcomes. […]

PV card: Ectopic pregnancy

By |Categories: ALiEM Cards, Ob/Gyn|

Ectopic pregnancy is the leading cause of maternal death in the first trimester of pregnancy. A recent JAMA systematic review,1 from The Rational Clinical Examination series, looked to risk-stratify women in early pregnancy presenting with abdominal pain or vaginal bleeding for ectopic pregnancy. The authors set out to identify the accuracy and precision of elements in the history, physical examination, beta hCG, and ultrasound in ectopic pregnancy. […]

Pediatric Appendicitis: CT or Ultrasound?

By |Categories: Pediatrics, Radiology|

Appendicitis is the most common pediatric surgical emergency accounting for 5% of urgent pediatric outpatient visits for abdominal pain. Computed tomography (CT) and ultrasonography (US) are two imaging modalities used in the diagnostic evaluation of acute pediatric appendicitis. Both have decreased the incidence of negative appendectomy results. It is well known that CT has greater diagnostic accuracy than US for diagnosing acute appendicitis, but there is concern over long-term cancer risk, with routine use of CT in children. What modality should be used for pediatric patients who are suspected of appendicitis? […]