Patwari Academy videos: The Crashing Neonate
In this series of videos, Dr. Rahul Patwari reviews the approach to the crashing neonate. Because these cases are often stressful, it is paramount to keep in mind a broad list of potential causes, such as “THE MISFITS” mnemonic: T rauma/abuse H eart disease E ndocrine (CAH, hyperthyroid) M etabolic (hypoglycemia, hyponatremia) I nborn errors S epsis F ormula mishaps I ntestinal catastrophes T oxins (home remedies) S eizures [+]
ALiEM Sim Case Series: Mass Casualty Building Bombing
Case Writer: Nikita Joshi, MD Keywords: Mass casualty incident, building bombing, disaster, triage, ethics Educational Objectives Medical Develop system of triage to optimize patient outcomes in prehospital disaster setting Effectively utilize color coded tagging method to assist in categorizing patients Develop treatment plans to address immediate emergency conditions per ATLS protocols Communication Maintain team and personnel safety precautions Regularly provide updates to incident command center [+]
The Importance of Reciprocal Changes in Lead aVL
ECG interpretation is one of the most important skills to master as an emergency physician, and its interpretation can be very complex and frustrating. ECG manifestations can be very subtle, and sometimes the earliest and only ECG change seen will be reciprocal changes alone. To further complicate this, many patients have the atypical symptoms of nausea/vomiting, weakness, or shortness of breath and not chest pain. [+]
Mythbuster: Calcium Gluconate Raises Serum Calcium as Quickly as Calcium Chloride
LET’S START WITH THE FACTS We know that calcium chloride (CaCl2) provides 3 times more elemental calcium than an equivalent amount of calcium gluconate. So, CaCl2 1 gm = calcium gluconate 3 gm. CLINICAL QUESTIONS Does CaCl2 have better bioavailability than calcium gluconate? Does calcium gluconate have a slower onset of action because it needs hepatic metabolism to release the calcium? [+]
Geriatric Blunt Trauma – Respect the Lactate
Which is a better prognostic tool in geriatric trauma, traditional vital signs or lactate level? Meet Norma Nuance (NN), a 70-year-old woman with CAD, HTN, HLD, DM, and mild dementia. She was involved in an MVC as the restrained driver with questionable LOC. She arrives in your ED and appears confused, but has a history of dementia. There are no family members to tell you her baseline. Her BP is 120/80, and her HR is 90. She is not calling out in pain, but does mumble about her left arm when you ask if she is hurting. You think she [+]
Welcome new series Geriatric EM by Dr. Christina Shenvi
Welcome a new superstar blogger, Dr. Christina Shenvi (@clshenvi), to the ALiEM team. If there’s one talent I have, it’s spotting the rising academic star. As the new Geriatrics EM fellow at the University of North Carolina, she’ll be starting her monthly series of blog posts on Geriatric EM. I jumped at the chance when she came up with the idea of this series, since there is never enough teaching about the unique aspects in the emergent care of older patients. Since meeting her in March 2013 at the annual CORD meeting, it’s been the longest 4 months anxiously waiting [+]
Patwari Academy videos: Anticoagulation and reversal agents
Bleeding in general is bad. Bleeding while on anticoagulants is VERY bad. Dr. Rahul Patwari reviews the pathophysiology of coagulation, the various reversal agents, and treatment approaches we can use. In this five-part series where all videos are less than 10 minutes, Rahul goes from the basic physiology of coagulation all the way to the complex reasoning and approaches to reversing anticoagulants. These are worth a quick look and review. [+]
ALiEM Book Club: The Immortal Life of Henrietta Lacks
Just like scores of other premedical students all striving to get acceptance to medical school, I volunteered and did research during college. I elected to work in the Virology department because I wanted to study viruses like HIV, RSV, and SARS that were causing havoc on our society. I do recall that we used HeLa cells frequently in our research. In fact, most scientists in that department used HeLa cells on a regular basis regardless of the focus of their projects. I didn’t think much of the cells and I definitely never thought of where or from whom those cells [+]
Launching the ALiEM Book Club
Everyone involved in medicine has read a significant amount of books over their lifetime. Some of those books were read willingly, whereas others not so willingly (sorry, Histology textbook). Regardless, most of us have an inner love of reading and continue to do so even when we are not forced to do so for a test or class. We are launching “The ALiEM Book Club”! [+]
The Dirty Epi Drip: IV Epinephrine When You Need It
You’re a recent graduate picking up an extra shift in a small ED somewhere north of here. At 3 AM an obese 47 year-old woman presents with shortness of breath and difficulty speaking after eating a Snickers bar an hour earlier. She admits to history of hypertension, peanut allergy, and a prior intubation for a similar presentation. She is becoming more obtunded in the resuscitation room as you are collecting your history. A glance at the monitor shows: HR 130 BP 68/40 O2 saturation 89% on room air [+]