• Ectopic Pregnancy

Paucis Verbis: Methotrexate for ectopic pregnancy

By |Categories: ALiEM Cards, Ob/Gyn|

Ectopic pregnancies account for as many as 18% of patients who present with first-trimester bleeding or abdominal pain in the Emergency Department. This Paucis Verbis card summarizes the 2008 American College of Obstetricians and Gynecologists (ACOG) guidelines on the use of methotrexate (MTX) for ectopic pregnancies. Not all ectopic pregnancies require operative management. […]

Trick of the Trade: Ultrasound-guided injection for shoulder dislocation

By |Categories: Orthopedic, Tricks of the Trade, Ultrasound|Tags: |

Who loves relocating shoulder dislocations as much as I do? I know you do. Often patients undergo procedural sedation in order to achieve adequate pain control and muscle relaxation. Alternatively or adjunctively, you can inject the shoulder joint with an anesthetic. Personally, I have had variable effectiveness with this technique. In cases of inadequate pain control, I always wonder if I was actually in the joint. How can you improve your success rate in injecting into glenohumeral joint injection? […]

  • Overdose

Paucis Verbis: Acetaminophen toxicity

By |Categories: ALiEM Cards, Tox & Medications|

Did you know that the American Association of Poison Control Centers reports that 10% of poison center calls are related to acetaminophen ingestions? That’s a lot. This Paucis Verbis card reviews the basics of acetaminophen toxicity. I included the Rumack Matthew nomogram to help you plot out the patient’s risk for hepatotoxicity. In the Emergency Department, we often screen for acetaminophen toxicity for patients who may have ingested substances as a suicide attempt. We check the serum acetaminophen level 4 hours post-ingestion. Occasionally, we are surprised by a toxic level because in the first 24 hours, because symptoms are can [...]

  • Nebulizer Mask

Trick of the trade: Nebulized naloxone

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

Overdoses of long-acting opiates, such as oxycodone and methadone, are challenging to manage, especially if these patients are chronically on opiates. On the one hand, you want to reverse some of the sedative effectives with naloxone so that they aren’t near-apneic and hypoxic. You also want to be able to take a history from them. On the other hand, you don’t want to abruptly withdraw them with naloxone such that they become violent and agitated. It is a fine balancing act. Long-acting opiates present a separate challenging because naloxone wears off fairly quickly in 30-45 minutes. These patients may require repeat [...]

  • Swine Flu

Paucis Verbis: Influenza – To treat or not to treat?

By |Categories: ALiEM Cards, Infectious Disease|

It’s coming. Influenza season is almost upon us. Influenza season typically peaks in the United States during the Jan-Feb months and can start as early as October. You can read about the 2011-12 seasonal flu data on the CDC website. Should you give a patient with influenza an antiviral agent or just provide supportive therapy? […]

  • Head Elevated Trumpet

Trick of the Trade: Nasal cannula oxygenation during endotracheal intubation

By |Categories: Tricks of the Trade|Tags: |

You are managing a 300-pound patient with a long history of severe COPD, who now requires intubation because of a pneumonia and COPD exacerbation. You anticipate that the patient may be a difficult airway intubation and may desaturate quickly during laryngoscopy. While you are setting up to orotracheally intubate this patient, you preoxygenate this patient as best as you can with a non-rebreather mask. What can you do to prolong the patient’s time-to-desaturation so that you aren’t as rushed to place the endotracheal tube? […]

  • Ventilator

Paucis Verbis: Ventilator settings for obstructive lung disease

By |Categories: ALiEM Cards, Pulmonary|

Following up with last week's Paucis Verbis card on Ventilator Settings for Acute Lung Injury and ARDS, here is the card on Ventilator Settings for Obstructive Lung Disease. This is for patients who present with acute asthma or COPD exacerbation who require endotracheal intubation. What initial ventilator settings should you set for these patients?   Go to the ALiEM Cards site for more resources. Thanks to Dr. Jenny Wilson for the card and Dr. Scott Weingart for the original stellar podcast from which this card was derived.