Author: Dan Ostermayer

You get a patch from EMS that they are bringing in a patient from dialysis with a complication of their AV fistula. Take the time now to update yourself on bleeding fistulas, clotted fistula, and more at WikEM – Dialysis Complications.… Read more

Dosing emergent factor replacement in the management of hemophilia (A &B) requires a small amount of mental math.

• For Hemophilia A: 1 IU rFIX/kg will increase the plasma concentration by 2%
• For Hemophilia B: 1 IU rFIX/kg will increase the plasma concentration by 1%

… Read more

As winter is upon those in the United States, make sure you are treating your patients with pneumonia using the appropriate antibiotics.   Outpatient treatment is divided among those with significant comorbidities and those without.  The inpatient regimens distinguish between hospital associated, community acquired and those requiring the ICU.… Read more

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 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

This month’s newsletter highlights the many complications of patients with a transplant.… Read more

Pepper (oleoresin capsicum) spray is a commonly used riot-control and violence suppressive agent. It was first used by Federal Bureau of Investigation personnel in the US in 1973.  Commonly encountered effects include conjunctivitis, blepharospasm, and self induced corneal abrasions. Early decontamination minimizes the irritant effects.  Although the majority of the uses do not cause life threatening clinical effects many patients in custody or after exposure present to the Emergency Room. This wiki page will help you navigate the patient who just got Maced!… Read more

Esophageal impaction can result in airway obstruction, stricture, or perforation. The perforation can be due to multiple mechanisms but is generally either mechanical (ingested bones) or via chemical corrosion (button battery). The most common sites of obstruction are the:

 

• Cricopharyngeus (near C6) muscle is the most common (about 75%)
• Aortic cross over the esophagus
• Lower Esophageal Sphincter

Although uncomplicated food impactions (no bones, incomplete obstruction) can be managed expectantly, it should not be allowed to remain for  > 24hrs.  Endoscopy is the only difinitive method to ensure removal but carbonated beverages and glucagon can be considered. Only one RCT of glucagon with 24 patients compared glucagon to diazepam and found no difference in the need for endoscopy.… Read more

Welcome to WikEM!  The Emergency Medicine residency directory has received a lot of attention, and we encourage everyone affiliated with a residency to take a moment and edit their residency page.  These pages give access to important information for future and current EM residents.  The directory can be edited by any registered user so if your program or country is missing, please add it in.  Like all wiki pages, you will receive a notification by email any time anyone edits your residency page.

A few examples:

• Residents can keep rotation scheduling up to date
• Residency coordinators can ensure all contact information is accurate
• Residency directors can highlight important facts for new applicants
• Graduates can read about changes to their residency page and learn that the educational curriculum

… Read more

WikEM maintains a list of pages that are needed so that new and existing editors can have a place to begin writing.  Check out the needed pages section for a list of new pages to create.… Read more