The Blog

Thanks for dropping by! We have curated an incredible collection of the best articles from the leading Emergency Medicine, Tactical Medicine, Prehospitial Medicine, Austere & Remote Medicine authors, as well as Survival Medicine gurus and many others!

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As always, all credit is given to the original author and origin publication.

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Tactical Medicine News

Trick of Trade: Large-Bore Endotracheal Tube To Suction the Occluded Airway

by Brenda Sokup, DO
Oct 31, 2021
The paramedics just arrived with a new patient to the resuscitation room. You find an altered patient actively vomiting bloody vomitus and food par...
Tactical Medicine News

Pre-Arrest Acidemia and the Effect of Sodium Bicarbonate on ROSC

Background Sodium bicarbonate during a cardiac arrest is widely debated and used in many cases. In a 2018 PULMCrit post, Dr. Josh Farkas reviews mu...
Tactical Medicine News

Beta-Blockers for Inhalant-Induced Ventricular Dysrhythmias

Background There are a few unique scenarios when beta-blockers may be indicated for patients in cardiac arrest. Use of esmolol for refractory ventr...
Tactical Medicine News

Trick of the Trade: Upsize the IV with the tourniquet infusion technique

There you are, middle of the night and EMS just brought you one of the sickest of the sick: a septic-looking, chronically ill-appearing, frail, and...
Tactical Medicine News

2020 ACLS Guidelines on Medications for Toxicology-Related Conditions

The 2020 ACLS guidelines provide recommendations on the medication-specific management recommendations for toxicology [1]. Although the name of the...
Tactical Medicine News

2020 ACLS Guidelines on Medications for Management of Specific Arrhythmias

The 2020 ACLS guidelines provide recommendations on the medication-specific management for arrhythmias including wide-complex tachycardia, regular ...
Tactical Medicine News

2020 ACLS Guidelines on Vasopressors and Non-Vasopressors During Cardiac Arrest

The 2020 ACLS Guidelines were published in October 2020 [1]. This first of 3 blog posts will focus on vasopressor and non-vasopressor medications d...
Tactical Medicine News

ACEP E-QUAL: The Electronic ICU

  Building on already increasing interest in telehealth, the COVID-19 pandemic accelerated the development and implementation of telemedicine servi...
Tactical Medicine News

SAEM Clinical Image Series: Distended Abdomen after ROSC

A 64-year-old female presented to the emergency department (ED) in cardiac arrest. Her family members heard her fall in the bathroom and started ...
Tactical Medicine News

Just-in-Time Training for Emergency Medicine Radial Arterial Line Placement

A 63-year-old male presents for acute onset of headache, neck pain, and altered mental status. He has a prior history of hypertension and hyperlipi...
Tactical Medicine News

End-Tidal CO2 in Cardiopulmonary Resuscitation

End-tidal CO2 (EtCO2) monitoring is a measure of metabolism, perfusion, and ventilation. In the ED, we typically think of a EtCO2 as a marker o...
Tactical Medicine News

The 4 T’s of Postpartum Hemorrhage

A 28-year-old G4P3 at 41 weeks presents to the ED via EMS. She is in active labor. On exam, a neonatal head is visible. Two minutes later, you ...
Tactical Medicine News

IDEA Series: A Low-fidelity Simulation Workshop for Teaching Cricothyroidotomy

The Problem Cricothyroidotomy is an emergency life-saving procedure that involves surgical placement of a tube through the cricothyroid me...
Tactical Medicine News

Trick of the Trade: Bubble Study for Confirmation of Central Line Placement

The safe placement a central venous catheter (CVC) remains an important part of caring for critically ill patients.1 Over 5 million CVCs are pl...
Tactical Medicine News

Accidental Hypothermia and Cardiac Arrest: Physiology, Protocol Deviations, and ECMO

Accidental hypothermia is a life threatening condition that can lead to a challenging resuscitation. The very young, old, and intoxicated patient a...
Tactical Medicine News

Resuscitation of a Drowning Victim: A Literature Review

Drowning cases peak this time of year and represent a leading cause of mortality in children. For example, drowning represents the leading cause o...
Tactical Medicine News

ALiEM Cards: Tumor Lysis Syndrome

Tumor lysis syndrome (TLS) is an oncologic emergency characterized by life-threatening metabolic disturbances. Although it is most frequently assoc...
Tactical Medicine News

ALiEM Cards: Acute Respiratory Distress Syndrome – Berlin Definition

Acute respiratory distress syndrome (ARDS) is a complex, life-threatening form of respiratory failure. It is responsible for almost 75,000 annual d...
Tactical Medicine News

PEM Practice Changing Paper: Clinical Trial of Fluid Infusion Rates for Pediatric DKA

Most protocols for managing pediatric patients with diabetic ketoacidosis (DKA) are based on a theoretical association between fluid resuscitation ...
Tactical Medicine News

The Myth of Vasopressors and Ischemia

Despite the widespread clinical use, and their well-documented life-saving properties, vasopressors are often maligned, accused of causing ischemia...
Tactical Medicine News

ECMO for ARDS: Key Pearls for Emergency Physicians from the EOLIA Trial

The role of extracorporeal membrane oxygenation (ECMO) in the management of acute respiratory distress syndrome (ARDS) has been a source of debate ...
Tactical Medicine News

Climate Change and Emergency Medicine: A Specialty on the Frontline

Emergency medicine (EM) is on the frontlines of climate change, which the Lancet Commission declared “the biggest global health threat of the 21st ...
Tactical Medicine News

Troubleshooting the Crashing Patient with a Tracheostomy

Patients presenting to the ED with respiratory distress and a tracheostomy can unnerve almost any provider, and management is often fraught with pr...
Tactical Medicine News

ALiEM Cards: Keeping the Sepsis Definitions and Criteria Straight

In 2015 the Centers for Medicare and Medicaid Services (CMS) adopted the Sepsis Bundle Project, which is a quality improvement project aimed at red...
Tactical Medicine News

Team-Focused CPR: Bringing Pre-hospital Success to the ED

High-quality chest compressions and early defibrillation are the cornerstones of effective cardiac arrest care.1 When implemented correctly these t...
Tactical Medicine News

ALiEM’s Greatest Hits for Interns: A Curated Collection of High-Yield Topics

Congratulations, you’ve made it! On July 1, thousands of medical students across the country made the transition to becoming Emergency Medicine re...
Tactical Medicine News

ED Charting and Coding: Critical Care Time

After a STEMI activation from the field on Monday morning, the cardiac catheterization team scoops the patient away shortly after the paramedics ar...
Tactical Medicine News

Trick of the Trade: Rapid Insertion of Orogastric Tube

We have all been in the situation: an intubated patient needs an orogastric (OG) tube and no one has been able to place it successfully. Unfortunat...
Tactical Medicine News

PV Card: LVAD Complications

Patients with left ventricular assist devices (LVAD) often cause much anxiety amongst providers in the emergency department. This is understandabl...
Tactical Medicine News

AIR Series: Procedures Module (2016)

Welcome to the Procedures Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index the ALiEM AIR Team i...
Tactical Medicine News

Trick of the Trade: Tibial Intraosseous Line Stabilization in an Agitated Patient

With the advent of commercial intraosseous (IO) needles for vascular access, administering IV medications for patients in extremis has been made mu...
Tactical Medicine News

AIR-Pro Series: Critical Care (part 2) Module

Welcome to the Critical Care (Part 2) Block! Below we have listed our selection of the highest quality posts related to 4 advanced level questions ...
Tactical Medicine News

Trick of the Trade: Pre-Charge the Defibrillator

In cardiac arrest care it is well accepted that time to defibrillation is closely correlated with survival and outcome.1 There has also been a lot ...
Tactical Medicine News

Trick of the Trade: Securing the intraosseous needle

So much attention is appropriately focused on the anatomy and technique for intraosseous needle placement. In contrast, very little attention is pa...
Tactical Medicine News

AIR Pro Series: Critical Care, Part 1 (2016)

Below we have listed our selection of the 12 highest quality blog posts related to 5 advanced level questions on critical care topics posed, curate...
Tactical Medicine News

Highlights from the 2015 American Heart Association CPR and ECC guidelines

The newest round of the 2015 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) c...
Tactical Medicine News

PV Card: Continuous End Tidal CO2 Monitoring in Cardiac Arrest

For many years, end tidal CO2 monitoring initially was helpful in differentiating tracheal versus esophageal intubations. Now with continuous end t...
Tactical Medicine News

Your Patient In Extremis: THAM To The Rescue?

One of the final common denominators dictating the success or failure of any resuscitative effort, be it a trauma or medical code, is the patient’s...
Tactical Medicine News

Trick of the Trade: Squeeze test for confirmation of IO placement

Venipuncture is the most common invasive procedure performed in the emergency department 1 , likely due to the fact that the vast majority of our l...
Tactical Medicine News

Blast From the Past: Occult Sepsis, Lactic Acid, and Mortality

Severe sepsis and septic shock affect millions of patients worldwide and have high rates of morbidity and mortality as well as high resource utiliz...
Tactical Medicine News

Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) Trial

Currently, guidelines recommend therapeutic hypothermia for comatose adults with out-of-hospital cardiac arrest (OHCA). A recent trial of adults wi...
Tactical Medicine News

Ultrasound for Verification of Endotracheal Tube Location

In patients undergoing emergent tracheal intubation, there is currently no universally accepted gold-standard test to confirm the location of the e...
Tactical Medicine News

Esmolol Use in Cardiac Arrest

There is an abundance of sympathetic stimulation in patients who present in ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT...
Tactical Medicine News

Intraosseous Rapid Sequence Intubation

Intravenous (IV) rapid sequence intubation (RSI) is by most considered the gold standard practice for securing an airway in the critically ill. The...
Tactical Medicine News

ALiEM-Annals of EM Journal Club: Targeted Temperature Management

We are very excited this month to bring you our third Global Journal Club. We hope you will participate in an online discussion based on the clinic...
Tactical Medicine News

Trick of the Trade: Nasopharyngeal Oxygenation

A 76-year-old obese male with a history of severe COPD presents to your emergency department (ED) in acute respiratory distress. The patient’s larg...
Tactical Medicine News

Approach to Difficult Vascular Access

Intravenous (IV) access is a basic and invaluable skill for emergency physicians. For patients requiring rapid fluid resuscitation, airway manageme...
Tactical Medicine News

Applying to EM-Critical Care Medicine Fellowships: What you need to know

Emergency physicians (EPs) have been successfully training in and practicing critical care in the ICU for decades, though until recently board cert...
Tactical Medicine News

Mechanical CPR and the LINC trial

The first time I saw the Thumper performing CPR on a patient I thought “well, that makes sense.” Since then we have seen other devices, most notab...
Tactical Medicine News

Prehospital: Does QUICKER hypothermia equal BETTER hypothermia?

The short answer to this question is NO. Since the landmark post-arrest, therapeutic hypothermia studies published in 2002, 1,2  extensive efforts ...
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