Hero spotlight: Dr.Todd Raine
There are incredible people doing incredibly inspiring work in Emergency Medicine. I wanted to restart the hero series, which had fallen off the radar a few years ago, featuring amazing people in our specialty. Today’s hero spotlight is on Dr. Todd Raine (@RaineDoc). He is a Staff Physician and IT Coordinator at the Providence Healthcare Department of EM and Clinical Assistant Professor at the University of British Columbia’s Department of EM. Despite these notable accomplishments, he is famous in the social media world for his innovative creation of a Google-based EM search engine GoogleFOAM.com, which many of us use to perform [+]
Supraventricular Tachycardia (SVT): Are Troponins Necessary?
More than one third of patients will have chest pain associated with SVT causing providers to order troponins and other cardiac enzymes. Elevated troponins are not pathognomonic for CAD/ACS and could represent other etiologies such as sepsis, subarachnoid hemorrhage, and pulmonary embolism. Also, subsequent coronary angiography is not necessary for risk stratification in all cases. SVT causes a rapid heart rate, which is well documented as a cause for modest troponin elevation secondary to cardiac stretch, poor diastolic perfusion, and/or coronary artery vasospasm. [+]
Introducing #EMConf Twitter Hashtag
I would like to share with the national and global community an opportunity to participate in the weekly generation of learning pearls from Emergency Medicine residency conferences. The majority of U.S. EM residencies gather faculty and residents together on a weekly basis for a half-day of education on material covering the basics of EM education. This is happening in isolated silos at the individual learning institutions. And up until now it was difficult to share the wealth of knowledge gained outside of the learning institutions in real-time. [+]
Patwari Academy videos: Spider and Hymenoptera bites
These two videos continue on the theme of envenomations. Watch these great videos on the consequences and management of bites by spiders and Hymenoptera species (bees, wasps, ants). Hymenoptera bites can cause all sorts of complications, but one of the most worrisome includes anaphylaxis, which is also reviewed in the video. [+]
ALiEM Bookclub: The Checklist Manifesto
Introduction Checklists have now almost become status quo in current medicine. My earliest encounter with the surgical checklist phenomenon was during PGY1 as an off-service intern. At this point, early adopters were running around with “Checkmark” safety-pins on their surgical caps, trying to encourage everyone to take up the cause. There were jokes and exasperated sighs each time a case started, but most complied with the task at the behest of opinion leaders (often the senior OR nurses in the room). Two years later I returned to see a culture change. OR teams seemed to communicate better, things seemed to [+]
Pediatric febrile seizure: When do I need to do a lumbar puncture?
You are in the ED when a 7 month old is brought in by EMS after a witnessed generalized seizure. The grandmother reports that the child has had URI symptoms for a couple of days and then developed a fever today. Shortly after giving ibuprofen, the child began to seize with arms and legs twitching. The episode lasted approximately 8 minutes and when EMS arrived, the child was sleepy, but arousable. The glucose was 92 mg/dL en route. On exam in the ED, child is awake and staring at you to make the next move… Vitals: Temp 39C, P 136, [+]
Posterior Myocardial Infarction: How Accurate is the Flipped ECG Trick?
Posterior myocardial infarction (MI) represents 3.3 – 21% of all acute MIs and can be difficult to diagnose by the standard precordial leads. Typically, leads V7 – V9 are needed to diagnose this entity. Luckily, leads V1 – V3, directly face the posterior wall of the left ventricle and are the “mirror image” of the posterior wall of the left ventricle. [+]
Safe dosing of nebulized lidocaine
Serum lidocaine levels correlate well with observed clinical effects. As the concentration increases, lightheadedness, tremors, hallucinations, seizures, and cardiac arrest can occur. Levels > 5 mcg/mL are associated with serious toxicity. With so many concentrations (1%, 2%, 4%) and routes of administration available, the total dose of lidocaine is always a concern. [+]
Trick of the Trade: The PIPP for deep peripheral IVs in obese patients
The Case A 500-pound morbidly obese male presents to your ED complaining of mild shortness of breath and palpitations. A quick ECG shows SVT with a rate of 160 bpm. His BP is in the 130s systolic, and he is otherwise stable. You know you have a bit of time. Meanwhile, the nurses begin searching for veins to start an IV… [+]
Patwari Academy videos: Snake bites!
There are about 8,000 snakebites per year in the United States and 10% are fatal (see comments)! If this doesn’t scare you enough to view these videos, watch these videos to see Dr. Rahul’s Patwari’s amazing digital drawing skills. In addition to a brief 4-minute overview on snake bites, Rahul also goes more in depth about crotalids (rattlesnakes) and elapids (coral snakes) specifically. [+]