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
Category: FOAM
Dialysis Complications
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
VP Shunts
A 3 year female with history of VP shunt placed several months ago presents with a slight behavior change per parents.
What do you do next? What images are included in a shunt series? What is your differential?
Review this and more: Ventriculoperitoneal Shunt Problems… Read more
Pediatric Seizures
When faced with the next pediatric seizure that doesn’t respond to first line therapy, take a few seconds to review the second line treatments and dosing in the WikEM page on Pediatric Seizures!… Read more
Hone your pediatric skills with Pediatric Emergency Playbook!
Pediatric Emergency Playbook is a new pediatric EM podcast to help make tough calls when caring for acutely ill and injured children. Check out their great podcasts on:
This post is part of WikEM’s Blog and Podcast Partnership Program.… Read more
Vasopressors
The goal of vasopressor use is to reach critical organ perfusion pressure. Estimated required mean arterial pressures (MAP) are listed in the vasopressor review by organ. It is generally safe to aim for a goal map of 65 mmHg. Vasopressors also promote increased venous return and should be used in septic patients after failed response to adequate volume resuscitation.… Read more
Thromboelastography Primer
The Thromboelastography page contains a great review on TEG and ROTEM values as well as a reference for abnormal measurements of the coagulation curves.… Read more
The Wiki: A Key Social Media Tool
Correspondence in Annals of Emergency Medicine about WikEM’s important place in social media: http://authors.elsevier.com/a/
Blogs, podcasts, videocasts, social networks, and custom search engines are all important resources for stimulating research discussion and improving medical education. However, as acknowledged by Thoma et al, “to make effective use of this stream of knowledge, learners must filter and choose from myriad resources.”2 We suggest that the wiki is a key social media tool to organize and summarize this growing body of online information. It also has the added benefit of providing easy access to consensus information in the middle of a shift, allowing clinicians to provide better care while at the bedside.
Get credit for resident reading electives and asynchronous learning activities, while supporting open access medicine!
Urine Tox Screen Cross Reactivity
The urine tox screen has little clinical usefulness in the emergent workup of a poisoned or altered paitient and in general should not be ordered reflexively. This page lists the cross reactivity of many substances with the standard urine tox assay.… Read more