Succinylcholine and the Risk of Hyperkalemia

By |Jul 31, 2021|Categories: EM Pharmacy Pearls, Tox & Medications|

Background Succinylcholine is frequently used in the ED to facilitate intubation, but it may be avoided in some cases due to the risk of hyperkalemia. The underlying physiology of this effect appears to be directly related to its therapeutic mechanism of action. When succinylcholine binds to and activates acetylcholine receptors, it leads to an influx of sodium and calcium and and an efflux of potassium into the extracellular space [1]. Additionally, when these acetylcholine receptors are immature or denervated, it seems that these channels may stay open significantly longer, allowing for an increased  amount of potassium to exit the cell, [+]

How I Work Smarter: Katie Holmes, DO FACEP

By |Jul 28, 2021|Categories: How I Work Smarter, Medical Education|

One word that best describes how you work? Hustle Current mobile device iPhone 12 Pro Computer Macbook Air What is something you are working on now? Updated Curriculum for our EM Clerkship, VSAS, Conference Material, Intern Orientation planning, and more How did you come up with this Idea/Project? We are always trying to improve our curriculums to make them better based off of feedback from previous years! What’s your office workspace setup like? My kitchen counter or my office at the hospital. What’s your best time-saving tip in the office or home? Keep a To Do list and divide [+]

EM Match Advice: Program Directors Reflect on the 2021 Residency Match

By |Jul 21, 2021|Categories: EM Match Advice, Podcasts|

Dr. Mike Gisondi and Dr. Michelle Lin return for their annual review of the most recent Match in emergency medicine (EM) in latest episode of EM Match Advice. They were joined by a panel of 3 outstanding program directors, Dr. Jacob Ufberg (Temple), Dr. Amita Sudhir (University of Virgina), and Dr. William Caputo (Staten Island Medical Center). Was the EM Match more competitive this year? That’s a complicated question and you need to listen to the podcast discussion for the nuanced answer. The Slide: The Nitty Gritty Annual Numbers of the EM Match "The Slide" above is a summary of [+]

Education Theory Made Practical: Listen to the New Podcast Series

By |Jul 16, 2021|Categories: Academic, Medical Education, Podcasts|

The Education Theory Made Practical (ETMP) set of 3 e-books were published starting 2017, reviewing key education theory principles and practically framing the abstract into practical scenarios. This series was produced by the ALiEM Faculty Incubator in collaboration with the  International Clinician Educator (ICE) blog. These e-books can be downloaded for free in the ALiEM Library. We were surprised, humbled, and honored that Dr. Daniel Harper wanted to convert the popular e-books into a podcast series, with each chapter turned into short 10-20 minute podcast. As a pilot test, he converted Volume 1 into a set of 10 podcasts. Take [+]

How I Work Smarter: Gus M. Garmel, MD, FACEP, FAAEM

By |Jul 14, 2021|Categories: How I Work Smarter, Medical Education|

One word that best describes how you work? Compassionately Current mobile device iPhone Computer MacMini What is something you are working on now? Multiple projects, presently Microaggressions & Civility in the Workplace, Communication and Success in EM, and Coaching/Mentoring in EM. How did you come up with this Idea/Project? These are important topics; not a lot of information is available about these topics related specifically to EM despite the need. What’s your office workspace setup like? Standing wrap-around adjustable desk with good lighting, multiple computer monitors, and sufficient space to work so that I can keep needed materials close [+]

High-Dose Nitroglycerin for Sympathetic Crashing Acute Pulmonary Edema

By |Jul 10, 2021|Categories: EM Pharmacy Pearls, Pulmonary, Tox & Medications, Uncategorized|

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

By |Jul 7, 2021|Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER, Trauma|Tags: , , |

  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,, rID: 16139 [+]

How I Work Smarter: Christopher Lloyd, DO

By |Jun 30, 2021|Categories: How I Work Smarter, Medical Education|

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 [+]

  • keep going book

How We Have Kept and Will Continue to Keep Going | Summary of The Leader’s Library Discussion

By |Jun 29, 2021|Categories: Book Club, Leaders Library, Medical Education|

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

By |Jun 26, 2021|Categories: Cardiovascular, Critical Care/ Resus, EM Pharmacy Pearls, Tox & Medications|

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, [+]