N-acetylcysteine is a well established and effective treatment for acetaminophen overdoses. The 21hr IV dosing and the 72hr oral regimens are also well studied and effective in preventing hepatic damage. One often over-looked technical detail to administration of NAC occurs with pediatric patients. There is a require dilution that is weight based for children that helps prevent electrolyte and fluid complications. The manufacturer provides a weight based dosing for pediatric patients.… Read more
The myth of the stone heart
The myth of the stone heart has been passed down from medical text to medical text since the first case reports appeared in the literature in the 1930s. Digoxin inhibits the sodium-potassium ATPase pump leading to increased mycocardial calcium concentrations. Since calcium causes myocardial contraction, seemed possible that increasing intracellular levels of the calcium would produce cardiac tetanany.
Patients with digoxin toxicity who were given calcium did not have a statistically significant increase in mortality (22% versus 20%).… Read more
Subcutaneous Insulin for DKA
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
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
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
CO Poisoning
Its that time of year again when the risk of CO poisoning is on the rise. AMS? Should you be reaching for that ABG needle? Does your department own a co-oximeter? Does its readings correlate? Take a moment and review WikEM – Carbon Monoxide Toxicity.… Read more
Push Health’s low cost concierge software now has affordable per service malpractice insurance
Want to see patients when you are outside of your home facility, but worried about the malpractice risk? Push Health now has the perfect solution: per service medical malpractice insurance. If you qualify and become an affiliate, your patients pay a $5 fee at the time of services and you are covered with standard malpractice insurance when using Push Health’s mobile and internet software. It is that simple.
Now, you can invoice, message, keep medical records, and order laboratory tests for your concierge patients, friends, and family, all while being covered by medical malpractice insurance. Build your own practice with Push Health!
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
Make money editing emergency medicine review questions!
WikEM is currently collaborating with Osmosis, a medical education company funded by the Robert Wood Johnson Foundation to create a large bank of medical education questions under an open Creative Commons license. Working with medical students, Osmosis has produced around 650 emergency medicine questions so far. They are now seeking EM residents and attendings to double-check their work and make revisions where necessary. Osmosis is paying EM residents/attendings $1 per question reviewed (marked ready to be published) and $5 for any question that needs to be extensively revised or rewritten, as well as making a donation to WikEM for helping with this process.
If you are interested in helping revise the question pack and making some extra money, fill out the form at: Application Form. Osmosis… Read more