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

PEMsource is a pediatric emergency medicine resource site curated by the faculty and fellows of the Harbor-UCLA Medical Center pediatric emergency medicine fellowship. It has quick links to a range of tools (e.g. BiliTool), FOAM posts, key pediatric algorithms, evidence based reviews, sample ECGs, images, and more. Check it out before you see your next pediatric patient!… 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

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

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

• Over the weekend our iOS app received a major update to fix many bugs and improve the appearance of content.
• The website has quick links to the critical care quick reference, antibiotic guide, journal club, and popular pages
• The forum is available for discussion anything Emergency Medicine and new EM job postings
• The newsletter provides monthly updates on educational topics and highlights learning resources on the internet

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 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

Many non illicit drugs cross react with common drugs screened on the traditional urine drug screen.

• NSAIDs can cause false positive cannabinoid screens
• Sertraline can cause a benzo false positive
• Most benzodiazepine screens look for oxazepam which is a metabolite of diazepam and chlordiazepoxide. Therefore, lorazepam, alprazolam, and clonazepam are commonly missed.

What is the detection interval for marijuana on a UDS?… Read more