Mechanical vs Manual CPR Chest Compressions
When talking about Out of Hospital Cardiac Arrest (OHCA) there are really only three things that make a true difference on outcomes (i.e. survival and neurologic function): High quality, non-interrupted CPR Early defibrillation Therapeutic hypothermia The quality of CPR is often under appreciated and performed incorrectly (too slow and/or not hard enough). With mechanical CPR, chest compressions are delivered uninterrupted and at a predefined depth and rate. In my own practice I have seen these devices being used more and more, but my questions is do these devices impact outcomes? [+]
P-Video: Rule of 15 in anion gap metabolic acidosis
You have a patient with an anion gap of 30 and bicarbonate of 10 mEq/L. You also determine on VBG that the patient’s pCO2 is 25 mmHg. What trick of the trade can you use to quickly determine whether this low pCO2 is an appropriate compensation of the primary metabolic acidosis? Dr. Jeremy Faust and Dr. Corey Slovis explains the quick “Rule of 15”. [+]
Patwari Academy Videos: Evidence Based Medicine (part 4)
Dr. Rahul Patwari is a one-man statistics teaching machine. In part 4 of this Evidence Based Medicine series, he reviews advance concepts in statistics and calculations including: case-fatality rates, crude mortality rates, specific-mortality rates, years of potential life lost, and direct and indirect age adjustments. [+]
ALiEM Book Club: Reflecting on a Happy Coincidence
Coincidence can be very fortuitous. How exciting was it to have Shawn Achor deliver his keynote address about the Happiness Advantage at ACEP this past week? Three days after our Book Club Review was released? Best part of it all – none of it was planned. That definitely was a ‘happy coincidence’. :D Though I was not there, my Twitter feed lit up with Happiness resounding from ACEP on that first day. It seems his message resounded with many in the audience. [+]
P-Video: Sources for pediatric and adult fevers
Dr. Jeremy Faust is back with another P-video, which stands for Paucis Videos (paucis means “few” or “brief” in Latin) much like the Paucis Verbis cards. These P-videos are short video-based educational pearls for the practicing physician with a focus on Emergency Medicine and Critical Care. Here Jeremy shares two mnemonics, LUCAS and FEBRILE, to help you remember the common causes for fevers in pediatric and adult patients, respectively. [+]
Confessions of an Emergency Department Kid Helper
As I was rounding the corner from the adult area of the emergency department to the pediatric area I heard a child screaming at the top of his lungs, “I DON’T WANT A SHOT”. I knew at that moment I was being summoned. I walked into the room and I saw a mother with her 5 year old son in a full headlock, while a new intern was trying to look in his ears. I made eye contact with the intern said “maybe I can help” then turned my attention to mom and son. [+]
Patwari Academy Videos: Evidence Based Medicine (part 3)
In part three of this Evidence Based Medicine series, Dr. Rahul Patwari does a deep dive on more advanced concepts in statistics. Specifically, he reviews: odds, incidence, prevalence, and incidence rates. What IS the difference between incidence and prevalence? Ever wonder? [+]
ALiEM Bookclub: The Happiness Advantage
Introduction Happiness at work. If you’re like so many of the seasoned physicians in my life, this might seem like an oxymoron. But that’s exactly what Shawn Achor suggests can be your status quo. The old axiom that if you are successful you will become happier is out-dated and, as it turns out, not evidence-based. It seems like many things in medicine, we may have had it backwards. Maybe, he suggests, if you find a way to make yourself happier – you’ll actually be a better doctor… [+]
Treating Ischemic Stroke with tPA in the ED: Time is Brain
Ischemic stroke is an emergent and devastating neurologic disorder, and is a leading cause of both death and disability in the United States. With each minute of brain ischemia, two million neurons are irreversibly damaged. Total ischemic time is linked to functional outcome, and therefore, the role of the Emergency Department is paramount in the management of these patients. Fibrinolytic therapy has become a mainstay of therapy for acute stroke, but guidelines for the use of tPA are dynamic, and often even controversial. When you identify someone with symptoms of stroke, what is your approach to determining if a patient [+]
Residency Interview Tips
Interview season is an exciting and stressful time for applicants and for residency programs. Both sides are invested in finding the right fit, and the interview process is integral to the process. Unfortunately, being integral doesn’t mean its easy. Here are some tips to the interview process. [+]