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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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