Trick of Trade: Alternative to a Pressure Bag for IV Fluids
You have a severely dehydrated patient with a peripheral IV line, requiring urgent fluid resuscitation. However, the crystalloid fluids are not flowing freely. Multiple attempts were made to place this line with the latest having a flash of blood return and a smoothly flowing saline flush. You can not seem to find your pressure infusion cuff to squeeze the IV bag and accelerate fluid administration. Trick of the Trade: Manually provide positive pressure fluids using a 3-way stopcock Attach a 3-way stopcock between the angiocatheter and IV tubing. In the unused port, attach a 10 or 20 cc syringe. [+]
ALiEM AIR Series | Infectious Disease 2023 Module
Welcome to the AIR Infectious Disease Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Digital Impact Factor [1], the ALiEM AIR Team is proud to present the highest quality online content related to related to infectious diseases in the Emergency Department. 6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. More specifically, we identified 1 AIR and 5 Honorable Mentions. We recommend programs give 3 hours of III credit for this module. AIR Stamp of Approval and [+]
Mismatch: Why were there so many unfilled emergency medicine residency positions in 2023?
The Study In an Annals of Emergency Medicine paper, Preiksaitis et al. sought to identify program factors associated with unfilled post-graduate year 1 (PGY-1) emergency medicine (EM) positions in the 2023 Match [1]. The authors completed a cross-sectional, observational study using National Residency Matching Program (NRMP) data and examined 9 variables as potential predictors of unfilled PGY1 positions using regression analyses [2]. The Findings The authors identified 6 program characteristics associated with unfilled EM PGY-1 positions in the 2023 Match:, smaller program size (< 8 residents), Mid-Atlantic or East North Central location in the United States, prior accreditation by [+]
ACMT Toxicology Visual Pearl: The Heart Won’t Go On and On
Which cardiotoxic plant is shown? Lily of the valley Moonflower Morning glory Water hemlock White snakeroot [+]
Sheila Goertemoeller, PharmD, DABAT, ICPS
Drug and Poison Information Center
Cincinnati Children's Hospital Medical Center
Latest posts by Sheila Goertemoeller, PharmD, DABAT, ICPS [+]
ACMT Toxicology Visual Pearl: Marcel the Shell with Toxins
The venom from this pictured snail shares a primary mechanism of action with what other deadly toxin? Alpha-latrotoxin Botulinum toxin Bufotoxin Tetanus toxin Sarin [+]
ACMT Toxicology Visual Pearl: The Black Eschar
Which of the following is the most likely explanation for this skin lesion in a worker handling sheep hides? Bacillus anthracis Group A streptococcus Pseudomonas aeruginosa Staphylococcus aureus (Photo credit: CDC/ James H. Steele, Public domain via Wikimedia Commons) [+]
Alex Blackwell, MD
Department of Emergency Medicine
Carolinas Medical Center
Phenobarbital as First-Line Medication for Alcohol Withdrawal: Have You Switched From Benzodiazepines Yet?
Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? If not, you probably should be. Another old drug for a new indication, right? Well not exactly. Phenobarbital is indeed an older and relatively cheap drug (less than $20 per loading dose) that has gained some press recently for the treatment of acute alcohol withdrawal [1-3]. Why should you consider using phenobarbital as monotherapy rather than benzodiazepines? Phenobarbital used to be one of the standard treatments for ethanol (EtOH) withdrawal prior to the introduction of benzodiazepines. However, there [+]
Trick of Trade: Dual Foley catheter to control massive epistaxis
Massive epistaxis is considered a medical emergency that requires immediate attention. Symptoms of massive epistaxis include sudden and heavy bleeding from the nose, difficulty breathing, dizziness, and a rapid heartbeat. If left untreated, it can lead to significant blood loss, shock, airway obstruction, and even death. We report a case of a 50-year-old man with end stage renal disease with massive nasal bleeding from the left nostril, shortness of breath, and confusion. Initial Management After a rapid assessment, we inserted an anterior nasal pack, soaked in epinephrine, TXA, and an antibiotic-based lubricant. However, the bleeding continued from his nares [+]
Trick of Trade: Removal of Entrapped Metal Zipper
A young boy is brought to the pediatric emergency screaming at the top of his lungs by his parents. His penile skin is trapped in the zipper of his jeans. On a busy shift, you want a simple way to handle zipper injuries that minimizes pain, doesn't require resource-intensive procedural sedation, and is quick. Background The 4 most common types of zippers are nylon coil zip, plastic mold zip, metal zip, and invisible zip. Most of the techniques describing solutions on zipper entrapment in the medical literature are derived from case reports and case series. All revolve around understanding [+]
Trick of Trade: Inflating the Esophageal Balloon of a Blakemore/Minnesota Tube without a Manometer
A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. He looks really bad, stating that he has been vomiting blood. He is hypotensive. He then vomits a copious amount of blood right in front of you. You intubate the patient and initiate the massive transfusion protocol, but everything you pour into him seemingly comes right back out. The gastroenterologist on-call states that he is too unstable for endoscopy. It is time for a balloon tamponade device. You’ve trained for this and set up everything. [+]