New wiki redesign

Our new redesign is live! Please provide any comments on this forum thread https://forum.wikem.org/t/redesign-feedback/936

The login issues that have plagued many users especially on Android during the last week should hopefully be fixed.  Thank you for bearing with us as we grow.  As always, if you enjoy WikEM, please donate.  Everything from the software to the content is made for free and open use. Without a small amount of money software development and maintenance for WikEM is not possible.

 … Read more

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.

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.
Read more

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

Cerebral Venous Thrombosis

Cerebral venous thrombosis (CVT) is a rare disorder involving occlusion of the venous sinus (most commonly superior sagittal and lateral sinuses) .  CVT is a very difficult diagnosis with a highly variable onset that may include visual, neurologic or even infectious like symptoms.  Predisposing factors include:

  • Cancer
  • Pregnancy
  • Local infections (otitis media, sinusitis, cellulitis)
  • Hypercoagulable states
  • Trauma
  • Drugs (ecstasy, androgens, OCPs)
  • Compression of venous sinus (tumor, abscess)

Suspect CVT in patients presenting with headache, signs of increased ICP, or focal neurologic deficits, especially if any of above predisposing factors are present.  Do not use a D-dimer to rule out CVT. The workup includes, an MRI and MRV unless there is a contraindication, then… Read more

Many new updates

We are always working to make bedside knowledge more accessible and quickly available for clinicians and healthcare providers in emergency settings for free.

We keep all content free because were realize how important information and knowledge sharing is to daily clinical practice and because our users are our patrons and keep everything running.Read more

The diagnosis formerly known as ALTE

The AAP has formally changed the name of ALTE to Brief Unexplained Event (BRUE). The definition has also been formalized with more specific criteria and suggestions to empower the clinician to base the diagnosis on their suspicion rather than relying only on the caregiver’s history.

BRUE is an event occurring in an infant <1 year of age when an observer reports a sudden, brief (<1 min), and now resolved episode of ≥1 of the following without explanation:

  • Cyanosis or pallor
  • Absent, decreased, or irregular breathing
  • Marked change in tone (hyper- or hypotonia)
  • Altered level of responsiveness
  • Must have returned to baseline
Read more