In the U.S. most DKA is managed in the ED with IV insulin drips, but short acting subcutaneous regimens can be just as effective. The subcutaneous regimen should utilize asparte not regular insulin and requires dosing at 1hr or 2 hour intervals depending on the chosen protocol. The subQ regimen is more utilized in Europe but is worth discussing with your pharmacist in order to have an alternative means of managing a DKA patient.… Read more
Author: Dan Ostermayer
The Complexities of RSI
Mastery of RSI is important for both procedural success and quality care. In children, the many nuances of RSI drug dosing, routes and medications become even more apparent.
- Should you use etomidate or ketamine?
- Succinylcholine or Rocuronium?
- Considerations for Trauma
- Vasopressor use during RSI
Dr. Horeczko outlines many of the nuances of RSI to guide you though mastery of pediatric intubation. The WikEM critical care quick reference, RSI and Vasopressor page will provide a reference for your next critically ill child.… Read more
Bleeding and Anemia in a Jehovah’s Witness
The bleeding Jehovah’s Witness patient presents a serious problem, especially if actively bleeding. For the acute traumatic bleeding, early hemorrhage control and autotransfusion are the only options. For severely anemic patients erythropoietin stimulation, aggressive iron and vitamin administration are the safest most widely accepted methods.… Read more
The many uses of capnography
Quick Pearl of the Day: End Tidal CO2 monitoring has many uses besides for procedural sedation.
-In cardiac arrest low values indicate poor chest compressions
-Rapid jumps in values can indicate ROSC
-Persistently low values (<10) indicate poor prognosis in prolonged cardiac arrest
A Global Residency Directory
Residents and attendings globally can now add information about their residency program to WikEM. The U.S. residencies have been pre-populated. Although most residencies have a central webpage, many of the rotation details are not publicly available and continuously changing. Now new applicants can quickly review a program’s educational curriculum, compare rotations, and learn more about residencies in their country. Faculty can use the resource to learn about the curriculum of other institutions and bring ideas back to their own hospital
To update your residency program:
1. Click on your residency program link
2. If your residency is not on the page you can add it.
3. Load the residency template if your residency hasn’t… Read more
To Image or Not to Image
With blunt head trauma, the most frequent question is: “CT brain or no CT brain”: The Head CT in Trauma (clinical decision rule) will help you make your decision.
Other useful guides:
… Read moreComplicated Deliveries in the ED
Before your next precipitous delivery arrives in the ED, take a moment to review these important pages for:
… Read moreNew Senior Assistant Editor – Michael Holtz
Congratulations to Dr. Michael Holtz on promoting to Senior Assistant Editor.… Read more
Recognizing our editors
There have been a lot of promotions among the core editorial group at WikEM. Without our highly skilled editorial team and the daily contributors, a global emergency medicine knowledge repository would not be possible. Thank you all! Also, all donations to our organization allow us to continue to improve the software for the world to use for free.… Read more
Antibiotics by Diagnosis
Antibiotics are hard to remember and during a busy shift we all just want a quick place to refresh our memory. The quick reference by system diagnosis provides a list of all the major treatments across the wiki. Updating a dosing or adding alternative treatments will update the antibiotic on all necessary pages and allow the world free and up to date access to antibiotic dosing.