32 year female with type 1 DM presents with fever, cough, nausea, and abdominal cramping. Finger stick on arrival is 357 and she has ketonuria on urine dip. What is the work up? When do you start supplemental potassium? Do you go for IV or subcutaneous insulin?
Take a moment to brush up on the management of Diabetic Ketoacidosis. Review the differences between IV and subcutaneous regimens. Expand your differential for causes. Know the risks of intubation.… Read more
67 year old male found in cardiac arrest. EMS performed one round of CPR, epi, and single shock before ROSC. On arrival he withdraws to painful stimuli, but is otherwise unresponsive and he does not open his eyes. Does this patient meet criteria for therapeutic hypothermia?
Take the time now to review the indications, contraindications, and management of post-cardiac arrest therapeutic hypothermia.… Read more
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
Osmosis.org has a new interview with the Creator and Editor-in-Chief of WikEM, as part their Leaders in Medical Education series. Read some of the history behind how WikEM started.
“If anything should be free and open in this world, then certainly the knowledge to care for your fellow human during an emergency has to be on the top of that list.” -Ross Donaldson, MD, MPH
Over the last six years, we have gone from having just a few people accessing the site per day to tens of thousands of sessions per month with over 100,000 downloads of the app to date. WikEM is now the most popular emergency medicine-specific application in the world and is open to all medical providers (including medical students) across the globe to help edit, as a key open access resource. We can now take that life-saving… Read more
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.
We’re pleased to announce that after a thorough review of our finances, the U.S. Internal Revenue Service (IRS) has recently recognized the OpenEM Foundation, the overarching organization supporting WikEM, as a 501(c)(3) nonprofit public charity.
Please donate now and help make open access to medical knowledge possible for all!
If there are any universals in this world, then chief among them is an innate human desire to care for our fellow beings when in suffering and extremis. Our goal is to make sure the knowledge to perform that important task is freely available to all. Thank you for your generous support.
The June Newsletter is out. Topics include hemophilia, Lyme disease, mammalian bites, and arthritis.… Read more
Which of the following patients does not warrant monitoring with telemetry after admission to the hospital?
A. AICD firing
B. Type II and complete heart block
C. Decompensated heart failure
D. Acute cerebrovascular accident
E. Massive blood transfusion
F. All of the above warrant monitoring
…an excerpt from The Kaji Review
Reference:
LLSA 2009: Chen EH and Hollander JE. When do patients need admission to a telemetry bed? J Emerg Med. 2007; 33(1): 53-60. full text… Read more
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
Scott Weingart has put out a great EMCrit Podcast on the treatment and diagnosis of Thyroid Storm. With thyrotoxicosis and thyroid storm being relatively rare diseases, wiki page highlights the treatment and diagnosis. The severity of hyperthyroidism, thyrotoxicosis and thyroid storm can be assessed with the Burch-Wartofsky score. Treatment is focused on: Aggressive supportive care and early propranolol administration to decrease peripheral hormone conversion and decrease sympathetic surge. Also along with propranolol, thionamide administration (specifically PTU) blocks new hormone synthesis. Iodide can be administered afterwards to prevent further hormone production.… Read more