New App Controls

Last month we had a disastrous bug that caused many users to download high definition images over their cellular connection.  In the coming app update we will be rolling out a new feature that allows for control over downloaded content. Although initially on iOS it will follow on android. From the updates icon on the WikEM app launch screen you can see the following toggles to control downloaded and updated content.

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New algorithm app!

You may have noticed algorithm diagrams supplementing various topics on WikEM. They’re part of the WikEM Algorithm Project, a continuing partnership with ddxof.com (differential diagnosis of). The WikEM algorithms are developed to serve as rapid emergency department references for differential diagnosis generation, clinical decision rule application, and critical management steps. They also serve as convenient teaching tools for educators.

You can now freely access all of the over 100 algorithms on your mobile device with the ddxof app. Download it today on the App Store and Google Play.Read more

Negative Pressure Pulmonary Edema

  • Negative-pressure pulmonary edema (NPPE)  occurs after a patient makes strong inspiratory effort against a blocked airway. The negative pressure causes hydrostatic edema that can be life-threatening if not but minimized if treated early, usually resolves after 24-48 hours.
  • Patients have and airway obstructive process either from an allergy, laryngospasm, trauma, and commonly in the case of hangings.
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The Current State of Refractory VF

The following guest post is written by MD candidate Joseph N. Ponce at McGovern Medical School, Houston TX, and describes the current state of evidence with adjunctive techniques to treat refractory VF.

Refractory ventricular fibrillation (RVF) is a life-threatening cardiac arrhythmia unresponsive to traditional methods of defibrillation and advanced cardiovascular life support (ACLS). Current literature lacks a uniform definition for RVF, however, some studies provide more specific clinical definitions of refractory ventricular fibrillation such as ventricular fibrillation that is resistant to at least three defibrillation attempts, 300 mg of amiodarone, and does not exhibit return of spontaneous circulation (ROSC) after > 10 min of cardiopulmonary resuscitation (CPR).… Read more

How to dose sugammadex

One of the newest drugs available to some EM provider is Sugammadex.  Trade name, Bridion, the drug functions as a reversal agent for Rocuronium.  An IV bolus of 16 mg/kg over 10 seconds via a central or peripheral line will reverse a single 1.2 mg/kg dose of rocuronium in approximately 3 minutes.  Although rarely used in the emergent setting, keep the dose in the back of your mind or reference on the WikEM app just incase you need to order it.… Read more

Neonatal Jaundice

Neonatal jaundice is one of the most common reason for newborns to return the hospital.  There are many risk factors and causes, with the most important piece of the workup being distinguishing direct vs indirect hyperbilirubinemia. Indirect hyperbilirubinemia can point towards a usually benign cause with breast feeding, breast milk and physiologic jaundice being the most common causes and present within the first 4-7 days of life.  Useful tools for risk stratification include the Bilitool for evaluating need for phototherapy.… Read more