High-Dose Nitroglycerin for Sympathetic Crashing Acute Pulmonary Edema
Background Nitroglycerin (NTG) is an important intervention to consider for patients with Sympathetic Crashing Acute Pulmonary Edema (SCAPE) as it significantly reduces preload, and even modestly reduces afterload with high doses. For acute pulmonary edema in the ED, NTG is often administered as an IV infusion and/or sublingual tablet. Starting the infusion at ≥ 100 mcg/min produces rapid effects in many patients and can be titrated higher as tolerated, with doses reaching 400 mcg/min or greater. Combined with noninvasive positive pressure ventilation (NIPPV) and in some cases IV enalaprilat, patients often turn around quickly, from the precipice of intubation to [+]
SplintER Series: One Big Bounce
A 5-year-old boy presents with right leg pain and a limp. His parents report it started after he was bouncing on the trampoline with his older sibling but they did not notice any specific trauma. He has tenderness over his proximal shin with no obvious injury. You suspect a fracture and obtain x-rays of the right knee (Figure 1). Figure 1. AP and Lateral x-rays of the right knee. Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 16139 [+]
How I Work Smarter: Christopher Lloyd, DO
One word that best describes how you work? Opportunistically Current mobile device iPhone 12 Pro Computer iPhone Xr What is something you are working on now? Qualitative analysis on resident perceptions of feedback How did you come up with this Idea/Project? As a program we are continuing to look at how feedback is being delivered to residents, when it is happening, how it is received/implemented, etc. This project grew from a desire to explore the resident perspective on these topics so as to understand better where we are effective with our feedback techniques and practices and where we can find [+]
How We Have Kept and Will Continue to Keep Going | Summary of The Leader’s Library Discussion
Last month, 30 people from 4 different countries and 15 different states + Puerto Rico, ranging from their early twenties to mid sixties, bravely jumped into a two-and-a-half day conversation on Slack about creativity, resilience, and their careers-- the fifth version of The Leader’s Library. We discussed the book Keep Going: Ten Ways to Stay Creative in Good Times and Bad by Austin Kleon, and reflected together on the evolution of our creativity from childhood through middle age, and how a career in emergency medicine requires creativity in every possible form. Please see our earlier post for a more detailed [+]
Beta-Blockers for Inhalant-Induced Ventricular Dysrhythmias
Background There are a few unique scenarios when beta-blockers may be indicated for patients in cardiac arrest. Use of esmolol for refractory ventricular fibrillation was summarized in a 2016 PharmERToxGuy post with an accompanying infographic. Another potential use for beta-blockers is in the rare case of a patient with inhalant-induced ventricular dysrhythmias. The term ‘sudden sniffing death’ refers to acute cardiotoxicity associated with inhaling hydrocarbons. Check out this ACMT Toxicology Visual Pearl for more information about the background and diagnosis of inhalant abuse. It is thought that inhalants causes myocardial sensitization via changes in various cardiac channels (e.g., sodium channels, [+]
SplintER Series: To Immobilize or Not to Immobilize: That is the Question
A patient presents to the Emergency Department after sustaining a twisting knee injury while skiing. She felt a pop and was unable to bear weight afterward secondary to pain and a feeling of instability. Shortly after the injury, she noted increased swelling and pain. On examination, she has a moderate effusion and a positive Lachman test. An x-ray was obtained and is shown above (Image 1. Case courtesy of Mikael Häggström, M.D. – Author info – Reusing images, CC0, via Wikimedia Commons). [+]
GroundED in EM: A new ALiEMU course series for third-year medical students
During the pandemic, similar to how a work-from-home mentality has become more accepted, a learn-on-own mentality has arisen for medical students. The success of the 9-part Bridge to Emergency Medicine (EM) self-guided curriculum for senior medical students interested in EM has confirmed this. This was evidenced by over 130,000 page views about the Bridge curriculum since March 2020 and 609 awarded ALiEMU certificates since April 2021 (launched only 2 months ago!). GroundED in EM: A new curriculum for third-year medical students We are thrilled to announce a 4-week, self-guided reading/listening curriculum along with choose-your-own-adventure cases paired now with ALiEMU quizzes, [+]
Are You Using the Right Evaluation Tool to Assess Learners? Putting Validity on Trial
As medical educators, we often rely on assessment tools to evaluate our learners. Whether in the form of a post-lecture survey or a checklist by a standardized patient assessment, tools are used throughout medical training and beyond. How do we know the tool we are using is appropriate? Is it assessing the right things? Do the scores have any meaning? We often search for tools that have been “validated” and feel more confident applying the results. But what makes a tool “valid”? With a few simple concepts, we can better choose and create our assessment tools and therefore better cater [+]
PEM POCUS Series: Pediatric Ocular Ultrasound for Optic Nerve Evaluation
Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric ocular ultrasonography for optic nerve evaluation. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit. Take the ALiEMU PEM POCUS: Pediatric Ocular Ultrasound Quiz - test your skills PATIENT CASE: Child with a Headache Madeline is a 15-year-old female presenting to the Emergency Department with chief complaint of a headache for 1 week. She has been struggling with headaches for more than a year. The headache has been intermittent and tends to [+]
SplintER Series: Attack by Bat
30-year-old male presents to the ED with pain over the right shoulder after being assaulted by a bat. The right arm is held in adduction and has a limited range of motion due to pain. An x-ray of the right shoulder was obtained and is shown above (Figure 1. Case courtesy of Dr. Ian Bickle, Radiopaedia.org, rID: 74640). [+]
