Alarms from the ventilator: Troubleshooting high peak pressures
Airway management is one of the defining skills of an emergency physician, but our role in the care of intubated patients may continue long after endotracheal tube placement is confirmed. In mechanically ventilated patients, acute elevations in airways pressures can be triggered by both benign and life-threatening causes. When the ventilator alarms, do you know how to tell the difference? What is your approach in troubleshooting the potential problems? [+]
Critical Care Series by new ALiEM writer Dr. Todd Seigel
Welcome a new superstar blogger, Dr. Todd Seigel (@ToddSeigelMD), to the ever-growing ALiEM team. I first met Todd at the recent Society of Academic Emergency Medicine meeting. At that time, he was an already established clinician-scholar-educator at Brown University. He had already graduated from residency and was returning to fellowship training to get his board-certification in Critical Care Medicine. I’m thrilled that he is now at my home institution (UCSF) doing this fellowship, where I couldn’t resist recruiting him to join our all-star cast of blog authors. Today is the first of hopefully a long series of critical care/resuscitation topics that are [+]
Quick clinical tip: Elson’s test for the finger
Injuries to the hand are fraught with multiple, concurrent injuries. Many injuries may have chronic debilitating complications, if not detected early. One such example is a finger laceration with a concurrent extensor tendon injury, causing delayed boutonniere deformity formation and limited function. Review the anatomy of the extensor tendon. View the video on how to perform the Elson’s test to detect a central slip tendon injury. [+]
Patwari Academy videos: ECG intervals and segments
Last week, the Patwari Academy videos covered ECG basics on rate, rhythm, and axis. Here is another set of three videos discussing ECG intervals and segments — specifically the PR interval, QRS interval, and ST segments. Again, this is a nice review on ECG concepts. [+]
NPR Ted Talks: A non-medical podcast ready to inspire
Most of us have heard of TED talks and most of us have heard of NPR. But did you know that the two have paired together to give a fascinating weekly radio discussion? Since March 2013, NPR reporter and radio host Guy Raz (@NPRGuyRaz) has brought together innovators, leaders, and entrepreneurs among others to the radio format to inspire and enlighten the listener. This amazing free resource is a valuable non-medical podcast for doctors to access. [+]
Acute Coronary Syndrome (ACS) in the Elderly
Acute coronary syndrome (ACS) is the number one cause of mortality in patients older than 65 years old. 1 To complicate this fact further, they also present atypically with weakness, nausea/vomiting, fatigue, and shortness of breath. It has been shown that older adults who present to the emergency department (ED) with ACS and a chief complaint other than chest pain have worse outcomes: [+]
Quick clinical tip: Ulnar collateral ligament injury
A common thumb injury is the “gamekeeper’s thumb or “skier’s thumb”, which involves an injury to the ulnar collateral ligament (UCL) of the first MCP joint. It is caused by forced abduction and hyperextension of the thumb, such as from a ski pole. But did you know that there are two branches of the ligament that you should test? [+]
Supraventricular Tachycardia (SVT) With Aberrancy Versus Ventricular Tachycardia (VT)
Differentiating between SVT with aberrancy and VT can be very difficult. It is crucial to be able to make this distinction as therapeutic decisions are anchored to this differentiation. Brugada et al prospectively analyzed 384 patients with VT and 170 patients with SVT with aberrant conduction to see if it was possible to come up with a simple criteria to help differentiate between the two with high sensitivity and specificity. [+]
ALiEM Book Club: THE CHECKLIST MANIFESTO – Join the conversation
New Horizons Do you like the ALiEM Book Club? Well we like you too!… so much so that we want YOU to join in on the next book discussion! We are taking the blog and book club to another level by pairing up with Dr. Teresa Chan (@TChanMD), an academic emergentologist from Canada. We are breaking the barriers of the internet and laying the foundation for a real-time, interactive discussion utilizing social media. [+]
Patwari Academy: ECG Rate, Rhythm, Axis
Dr. Rahul Patwari reviews the basics on how to determine an ECG’s rate, rhythm, and axis. It’s always nice to review these concepts. Do you remember how many seconds a traditional ECG typically spans on a single page? What’s the significance of the numbers: 300, 150, 100, 75, 60, 50? Spend a few minutes on these 2 refresher videos. [+]