Hyperkalemia Management: Preventing Hypoglycemia From Insulin
Insulin remains one of the cornerstones of early severe hyperkalemia management. Insulin works via a complex process to temporarily shift potassium intracellularly. Though insulin certainly lowers plasma potassium concentrations, we often underestimate the hypoglycemic potential of a 10 unit IV insulin dose in this setting. The purpose of this post is to highlight the need for proper supplemental glucose and blood glucose monitoring when treating hyperkalemia with insulin. This is such an important medication safety issue, the Institute for Safe Medication Practices (ISMP) highlighted it in a February 2018 Safety Alert. [+]
Trick of the Trade: TRUST ultrasound confirmation of pediatric endotracheal tube placement
Following intubation the confirmation of endotracheal tube placement and depth is essential. While dynamic etCO2 monitoring has revolutionized the confirmation of endotracheal placement, there are still several circumstances in which this modality may be misleading (e.g. prolonged arrest, severe status asthmaticus/PE/pulmonary edema, etCO2 detector contamination with drugs/gastric contents). Additionally, EtCO2 detectors cannot confirm appropriate endotracheal tube depth, leading to delayed recognition of mainstem placement. [+]
Diagnose on Sight: Lip Swelling
Case: A 24 year old male presents with right sided lip swelling that began several hours ago. This is the second time he has had this type of swelling. His mother has also had this before. He currently has no urticaria, dyspnea, wheezing, or stridor. What is the cause of this patient’s symptoms? [+]
I am Dr. Sam Ghali, EM Faculty and Ultrasound Expert at The University of Kentucky: How I Work Smarter
As you can see from our How I Work Smarter (HIWS) mapping post, Lexington Kentucky is emerging as a powerhouse of EM leaders and social media gurus. After WildcatEM HIWS contributions from Matt Dawson, Rob Rogers, and Chris Doty, we have Dr. Sam Ghali (@EM_ResUS) taking a swing. Dr. Ghali is an up and coming member of the SoMe circuit with a focus on point-of-care ultrasound, resuscitation, and critical care. Nominated by Haney Mallemat, Dr. Ghali generously shares his thoughts about career and life management. [+]
I am Dr. Nadim Lalani, Assistant Program Director and Life Coach: How I Stay Healthy in EM
Dr. Lalani (@ERMentor) is no stranger when it comes to wellness. He is without a doubt an individual who is always striving to improve himself on every level. Currently, he is the Assistant Program Director of the University of Saskatchewan FRCPC EM Program, creator of the blog ERMentor, and has recently completed his certification to be a Life Coach (check out his personal website here). When he’s not in the ED torturing his residents with his top secret set of tough questions, he can be found on the golf course working on his pro swing. Dr. Lalani is a mentor to many, [+]
A cost-effective, two-layer wound closure task trainer
Performing a two layer wound closure can be a challenging procedure in the Emergency Department for clinicians with limited wound care experience. Challenges include suture choice, suture placement, and the technique of burying the knot in the deep layer of the wound, and the availability of ready ‘volunteers’ with complex wounds willing to let novices practice on them. Commercially available suture models are expensive, and can be cumbersome to store, and difficult to obtain in a timely manner to provide the learner with opportunities to practice prior to wound repair on a patient in the department. [+]
4 Pitfalls of Bedside Ultrasonography During First Trimester Pregnancy
One of the more common indications for the use of bedside ultrasound (US) is to evaluate patients who present to the emergency department (ED) with pain or bleeding during the first trimester of pregnancy. When performing this study, providers should be aware of several potential pitfalls that pose significant risk to both the patient and the provider. [+]
Brian Bauerband, MD
I am Dr. Minh Le Cong, Royal Flying Doc and Author of the PHARM blog and podcast: How I Work Smarter
We are back from our break with more How I Work Smarter. We hope you enjoyed our new sister series Healthy in EM! Today we have a FOAM and Twitter staple weighing in: Dr. Minh Le Cong (@ketaminh). He is a senior officer with the Royal Flying Doctor Service in Australia. He holds quite a few degrees/certifications. In fact, we should really publish his full title: Dr. Minh Le Cong MBBS, FRACGP, FACRRM, FARGP, FACAsM, GDRGP, GEM, CertIVTAA, PGDAeroRT. He is the driving force behind the PHARM blog and podcast which focuses on out of hospital and retrieval medicine. Dr. [+]
ALiEM Bookclub: The Art of Choosing
“Choice is how we go from who we are today to who we want to be tomorrow.” Most people likely do not know Sheena Iyengar. However it is likely that you know about her famed “jam study.” In this study she had a tasting table at a grocery store with either 24 varieties of jam, 6 varieties, or only gourmet jam. Although the larger display was able to attract more customers, the customers from the smaller selection were 10 times more likely to purchase jam. This study stood in contrast to the assumption of retailers that more choice is better. [+]
Announcing the ALiEM-AgileMD Educational Design Fellowship
Based on the successes of our 2014-15 ALiEM-EMRA (for medical students), ALiEM-CORD (for residents), and ALiEM-AAEM Young Physicians fellowships, we are thrilled to be launching the 2015 ALiEM-AgileMD Educational Design Fellowship! The application process for this virtual fellowship is now open. [+]
