QI Series: Pitfalls in Diagnosing Hyperkalemia
A 55 year old male was brought to the Emergency Department (ED) by paramedics complaining of weakness and chest discomfort. His past medical history was notable for coronary artery disease with bypass grafting, diabetes mellitus, and end stage renal disease. He reported being non-compliant with his last 2 scheduled hemodialysis sessions. Paramedics noted pallor and recorded a blood pressure of 80/palpated and a heart rate of 44. Upon arrival to the ED, a 12 lead ECG was obtained. [+]
ALiEM Bookclub: Five Days at Memorial
Five Days at Memorial by Sheri Fink (@sherifink) invites us to examine what we expect of ourselves in the medical community during times of disaster: what is demanded by our Emergency Medicine training in triage, disaster management, and end of life care, and what ethics form the foundation of our practice when systems around us fail. Dr. Fink’s book offers an opportunity for us, as health care practitioners, to openly discuss with the communities we serve the ethics that crash into conflict in settings of unfathomable duress and insufficient resources. [+]
Sim Case Series: Procedural Sedation
Case Writer: Brent Thoma, MD MACase Editors: Teresa Chan, MD and Nikita Joshi, MD This procedural sedation simulation case can be used to teach, evaluate or reinforce the skills needed to safely perform procedural sedation. It presents a new format for the ALiEM Sim Case Series: Teresa Chan (@TChanMD) has worked magic to amalgamate all of the materials into a cohesive, organized, easy to follow format that also happens to be pretty. The freely downloadable PDF below includes: [+]
Insulin Pumps: Understanding them and their complications
While the rate of diabetes climbs, the number of patients who are using insulin pumps grows apace. Pumps appeal to physicians because they mimic normal insulin physiology with a consistent basal rate and appropriate bolus doses for meals. This leads to tighter glucose control and smaller variations. For patients, the pumps can be liberating, requiring far fewer injections than a typical multi-dose regimen. Regardless of why your patient has an insulin pump, it helps to know about how they work… for when they don’t. [+]
Mechanical CPR and the LINC trial
The first time I saw the Thumper performing CPR on a patient I thought “well, that makes sense.” Since then we have seen other devices, most notably the Zoll AutoPulse and the Physio-Control LUCAS. It was disappointing to many in 2005 when the AutoPulse trial was halted early due to harm. 1 Although four-hour survival was similar between groups, the hospital discharge survival rate in the manual CPR group was 9.9% compared to 5.8% in the mechanical CPR group. Many hypotheses were proposed to explain the results, which included Hawthorne effect, prolonged device deployment time, and enrollment bias. Last month, the results [+]
Child Whisperer Series: There’s an app for that!
I was playing bubbles with a 2 yr old when she wanted a turn. Even though I knew the outcome, she said “peeeze” so I said OK. As predicted, she immediately dumped the bubbles on the floor and started laughing. In the corner of the room I heard the quiet voice of her 10 year old brother say to me, “Excuse me, ma’am… you know there’s an app for that”. [+]
Get Started on Becoming a Recognized Speaker
Love sitting in the audience at national and local conferences listening to great speakers, but always have that nagging feeling that you also have something valuable to teach and share with the audience? Or have you ever wanted to directly confront your greatest fear of public speaking in front of your EM colleagues? Consider speaking opportunities through organization such as AAEM and ACEP! [+]
Prehospital: Does QUICKER hypothermia equal BETTER hypothermia?
The short answer to this question is NO. Since the landmark post-arrest, therapeutic hypothermia studies published in 2002, 1,2 extensive efforts have been made to ensure our post-arrest patients are cooled… and cooled fast. It only seemed logical to extend this revolutionary treatment into the field and have paramedics begin the cooling in the field. New EMS protocols were developed around the country to incorporate hypothermia into cardiac arrest management and well received by paramedics and EMTs. But a recent JAMA publication calls this now into question. 3 [+]
Bicarbonate: Completely Useless?
Intravenous sodium bicarbonate seems like a wonderful drug. It fixes acidosis, pushes potassium into cells, alkalinizes urine, and even helps with smelly feet. However, this literature review of four conditions casts some doubt into the seemingly cure-all that is bicarbonate. [+]
Modified Sgarbossa Criteria: Ready for Primetime?
The recognition of ST-segment elevation myocardial infarction (STEMI) in the presence of left bundle-branch block (LBBB) remains difficult and frustrating to both emergency medicine physicians and cardiologists. According to the 2004 STEMI guidelines, emergent reperfusion therapy was recommended to patients with suspected ischemia and new LBBB however, the new 2013 STEMI guidelines made a drastic change by removing this recommendation. Several papers have recently been published discussing a modified Sgarbossa’s criteria and a new algorithm to help decrease false cath lab activation and/or fibrinolytic therapy, but are they ready for primetime? [+]