The Blog

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Tactical Medicine News

EM Pharm Pearls: Estimated rise in blood glucose concentration with dextrose administration

by Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP
Jul 18, 2022
A common question is how much should we expect the blood glucose concentration to increase after dextrose 50% (D50) administration. Fortunately, th...
Tactical Medicine News

Balanced Fluids in Diabetic Ketoacidosis

Background Many guidelines and treatment algorithms for diabetic ketoacidosis (DKA) recommend sodium chloride 0.9% as the replacement fluid of choi...
Tactical Medicine News

SAEM Clinical Image Series: Facial Edema

A 44-year-old female presents to the emergency department after noticing swelling of her tongue and face, specifically the cheeks and periorbital a...
Tactical Medicine News

ALiEM AIR Series: Endocrine Module

Welcome to the Endocrine Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Te...
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

A Can’t Miss ED Diagnosis: Euglycemic DKA

A middle-aged man with a history of diabetes and hypertension presents with nausea, vomiting, and shortness of breath. His laboratory testing is re...
Tactical Medicine News

PEM Pearls: Treatment of Pediatric Diabetic Ketoacidosis and the Two-Bag Method

Insulin does MANY things in the body, but the role we care about in the Emergency Department is glucose regulation. Insulin allows cells to take up...
Tactical Medicine News

ALiEMU CAPSULES Module 7: Emergency Thyroid Disorders

We are proud to present CAPSULES module 7: Emergency Thyroid Disorders, now published on ALiEMU. Here is a summary of the key points from this outs...
Tactical Medicine News

PEM Pearls: Hydrocortisone stress-dosing in adrenal insufficiency for children

During your shifts in the pediatric ED, you may encounter a few patients with adrenal insufficiency or adrenal crisis. Some of the most common caus...
Tactical Medicine News

Trick of the Trade: Lactated Ringers for Sepsis Complicated by Hyponatremia

An 82-year-old female is brought into the Emergency Department by family for a several day history of progressive altered mental status. You initia...
Tactical Medicine News

Hyperkalemia Management: Preventing Hypoglycemia From Insulin

Insulin remains one of the cornerstones of early severe hyperkalemia management. Insulin works via a complex process to temporarily shift potassium...
Tactical Medicine News

Malignancy-Associated Hypercalcemia: Which Bisphosphonate is Best?

Malignancy-associated hypercalcemia (MAH) is the most common metabolic derangement encountered in the oncologic population in the ED. It can occur ...
Tactical Medicine News

D50 vs D10 for Severe Hypoglycemia in the Emergency Department

Think back to your last severely hypoglycemic and lethargic patient presenting to the ED. What was the first treatment modality that came to ...
Tactical Medicine News

Can Permanent Marker Leach into IV Infusion Bags?

You are resuscitating a hypotensive patient with severe sepsis and have just hung your 4th liter of crystalloid. On the fluid bags, you wrote the ...
Tactical Medicine News

Why Henderson and Hasselbalch Belong in the ED

If you’re like me, you learned and then promptly forgot the Henderson Hasselbalch equation (HH eq) in medical school.1 After all, in clinical rotat...
Tactical Medicine News

Mythbusting the Banana Bag

We’re all pretty familiar with the banana bag: intravenous (IV) fluids with the addition of thiamine, folic acid, multivitamins, and sometimes magn...
Tactical Medicine News

AIR Series: Endocrinology Module 2014

Welcome to the third ALiEM Approved Instructional Resources (AIR) Module! In an effort to reward our readers for the reading and learning they are ...
Tactical Medicine News

Antidiabetic Medications: Hypoglycemic Potential in Overdose

With several new diabetes medications available, it is important to know which ones are likely to cause hypoglycemia after overdose. Based on mecha...
Tactical Medicine News

Article: Hypotonic maintenance IV fluids in pediatrics

A 6-month-old male presents to the emergency department with diarrhea and vomiting. Despite antiemetic therapy, the the child is unable to tolerate...
Tactical Medicine News

QI Series: Pitfalls in Diagnosing Hyperkalemia

A 55 year old male was brought to the Emergency Department (ED) by paramedics complaining of weakness and chest discomfort. His past medical histor...
Tactical Medicine News

Insulin Pumps: Understanding them and their complications

While the rate of diabetes climbs, the number of patients who are using insulin pumps grows apace. Pumps appeal to physicians because they mimic no...
Tactical Medicine News

Bicarbonate: Completely Useless?

Intravenous sodium bicarbonate seems like a wonderful drug. It fixes acidosis, pushes potassium into cells, alkalinizes urine, and even helps with ...
Tactical Medicine News

Thyroid Storm: Treatment Strategies

The Case You have a 54-year-old female who presents to the emergency department with a chief complaint of “just feeling out of it.” She has felt “...
Tactical Medicine News

P-Video: Rule of 15 in anion gap metabolic acidosis

You have a patient with an anion gap of 30 and bicarbonate of 10 mEq/L. You also determine on VBG that the patient’s pCO2 is 25 mmHg. What trick o...
Tactical Medicine News

Diagnosing hyperthyroidism: Answers to 7 common questions

The prevalence of hyperthyroidism in the general population is about 1-2%, and is ten times more likely in women than men. The spectrum of hyperthy...
Tactical Medicine News

Dexmedetomidine (Precedex) as an Adjunct to Benzodiazepines for Ethanol Withdrawal

Sometimes a question is posed on Twitter that generates a great discussion from colleagues ’round the globe. Such was the case for dexmedetomidine....
Tactical Medicine News

PV card: VBG versus ABG

You obtain a venous blood gas (VBG) on a patient with a COPD exacerbation because you are concerned about hypercarbia. You get a value of 55 mmHg. ...
Tactical Medicine News

PV Card: Electrolytes and ECG changes

The electrocardiogram can pick up all sorts of electrolyte abnormalities. The most common abnormalities revolve around high and low levels of pota...
Tactical Medicine News

Paucis Verbis card: ABG interpretation

I have yet to find a better arterial blood gas interpretation review article than the 1991 Western Journal of Medicine summary by Dr. Rick Haber. T...
Tactical Medicine News

Paucis Verbis card: Hyperkalemia management

Hyperkalemia is a common presentation in the Emergency Department, especially in the setting of acute renal failure. In one shift, I had 4 patients...
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