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ACMT Toxicology Visual Pearl: Pretty (and Deadly) in Purple
by Charles Harris III, MD
Jun 06, 2022
What is the correct antidote for a patient who is poisoned with the pictured substance?
Digoxin Specific Fab
Hydroxocobalamin/Sodium Thiosulfate...
Tactical Medicine News
ACMT Toxicology Visual Pearl: Hypertension and Rash
Which toxic exposure can present with the pictured rash along with hypertension and tachycardia mimicking pheochromocytoma?
Arsenic
Lead
Mercury...
Tactical Medicine News
Blood Pressure Differences in Patients with Acute Aortic Dissections
Background An acute aortic dissection (AAD) can be a life-threatening emergency which frequently requires rapid and precise control of the patient’...
Tactical Medicine News
ALiEM AIR Series | ACS 2022 Module
Welcome to the AIR ACS Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is ...
Tactical Medicine News
SAEM Clinical Image Series: Painful Blue Arm
A 68-year-old male with a past medical history of hypertension, hyperlipidemia, and recent ileostomy secondary to small bowel obstruction presented...
Tactical Medicine News
SAEM Clinical Image Series: A Young Woman with Chest Pain
A 35-year-old female with a history of intermittent palpitations who is three months post-partum presented to the emergency department (ED) with th...
Tactical Medicine News
Retrospective Validation of High-Sensitivity Troponin with 5 Clinical Decision Instruments
Background: Chest pain is the second most common reason for presentation to the emergency department (ED) and accounts for nearly 6.5 million visit...
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
SAEM Clinical Image Series: Pulseless and Painful Blue Leg
A 57-year-old male who works as a truck driver with a history of hypertension, type 2 diabetes, and recent COVID-19 infection presents with right l...
Tactical Medicine News
Diagnosis on Sight: “I have a rapid heart rate”
A 31-year-old male presented to the emergency department with palpitations. The patient stated that he thinks his symptoms began "last night" and...
Tactical Medicine News
TTM2: Hypothermia vs Normothermia for Out-of-Hospital Cardiac Arrest
Background Information:
Hypothermia was first introduced in 2002 by two studies, Bernard et al and The Hypothermia After Cardiac Arrest (HACA) tria...
Tactical Medicine News
External Validation of the Canadian Syncope Risk Score
Background Information:
The Canadian Syncope Risk Score (CSRS) is one of several clinical decision tools used in the emergency department (ED) foll...
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
Safety and Efficacy of Clevidipine for Acute Blood Pressure Control
Background Rapid and precise control of blood pressure is vital for patients with a hypertensive emergency or an acute stroke. Commonly, nicardipin...
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
MIRACLE2 Risk Score for Early Prediction of Neurologic Outcome in Out-of-Hospital Cardiac Arrest
Background Information: Out-of-hospital cardiac arrest (OHCA) remains a diagnostic challenge to providers and a significant burden on healthcare sy...
Tactical Medicine News
ACEP E-QUAL: ACEP Non-STEMI Clinical Policy
In 2018, the American College of Physicians (ACEP) released a Clinical Policy with management recommendations for patients presenting to the emerge...
Tactical Medicine News
LVAD Part V: The Coding LVAD Patient
Left ventricular assist devices (LVADs) have moved from being a bridge to a heart transplant to destination therapy for patients with severe heart ...
Tactical Medicine News
LVAD Part IV: Non-Device Pathology
Left ventricular assist devices (LVADs) have moved from being a bridge to a heart transplant to destination therapy for patients with severe heart ...
Tactical Medicine News
LVAD Part III: Complications
Left ventricular assist devices (LVADs) have moved from being a bridge to a heart transplant to destination therapy for patients with severe heart ...
Tactical Medicine News
LVAD Part II: Diagnostic Evaluation
Left ventricular assist devices (LVADs) have moved from being a bridge to a heart transplant to destination therapy for patients with severe heart ...
Tactical Medicine News
LVAD Part I: Introduction
Left ventricular assist devices (LVADs) have moved from being a bridge to a heart transplant to destination therapy for patients with severe heart ...
Tactical Medicine News
Case of a Blue, Painful Finger
A 37-year-old female presented to the emergency department for evaluation of numbness and discoloration to her left fourth finger, which had starte...
Tactical Medicine News
Syncope as Easy as 1-2-3
A 66-year-old otherwise healthy man presents by Emergency Medical Services (EMS) after being found unconscious on the ground. On arrival to you...
Tactical Medicine News
Trick of the Trade: Combine Adenosine with the Flush
2019 literature update from this original 2012 Trick of the Trade post!
The success of adenosine depends as much on the administration technique...
Tactical Medicine News
Comparison of Chemical vs Electrical Cardioversion of Acute Uncomplicated Atrial Fibrillation
Background Information: Atrial fibrillation is the most commonly encountered dysrhythmia in the emergency department (ED) and is associated with an...
Tactical Medicine News
Differentiating pericardial effusion from pericardial tamponade on ultrasound
Tamponade physiology, in which a pericardial effusion impedes cardiac output, is a medical emergency and requires prompt diagnosis and interven...
Tactical Medicine News
SAEM Clinical Image Series: Another Heart Attack?
[Figure 1: Click for larger view]
Chief Complaint: Chest pain
History of Present Illness: An 89-year-old female with a past medical history of...
Tactical Medicine News
TRAPID-AMI: Predictive Symptoms of Acute Myocardial Infarction (AMI)
Background: Chest pain is a complaint commonly seen in the emergency department. Getting a good history is an essential part of working up patient...
Tactical Medicine News
No More Heparin for NSTEMI?
Background: The 2014 AHA guidelines for the management of NSTEMI, recommend unfractionated heparin with an initial loading dose of 60IU/KG (maximum...
Tactical Medicine News
ALiEM AIR Non-ACS Cardiovascular Module
Welcome to the Non-ACS Cardiovascular Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the...
Tactical Medicine News
30-Day Outcomes in Syncope vs Near-Syncope
Background: Syncope, defined as a transient loss of consciousness with spontaneous and complete recovery to pre-event status, is a common emergency...
Tactical Medicine News
2018 ACEP Clinical Policy for Patients with Suspected Non-ST Elevation ACS
A patient presents to your ED with an all too common complaint – chest pain. After a focused history and physical exam, you have an extremely low c...
Tactical Medicine News
The ORBITA Trial: PCI vs Placebo Procedure for Angina Relief in Stable Angina
Background:In the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial [2], there was no difference in MI a...
Tactical Medicine News
SCOT-HEART: CCTA Decreases Long-Term Risk of MI and Death?
Background: CT coronary angiography (CTCA) is a relatively new technology that has gained popularity over the past few years in evaluating patients...
Tactical Medicine News
LOMAGHI Trial: Magnesium Sulfate for Rapid Atrial Fibrillation?
Background: Currently, several medications are recommended for the management of atrial fibrillation with rapid ventricular response in the emergen...
Tactical Medicine News
Ultrasound For The Win! – 57F with Chest Pain and Dyspnea #US4TW
Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real clini...
Tactical Medicine News
Why we Should Consider Not Using Morphine in Acute Heart Failure
Background/Introduction: Acute heart failure is a common diagnosis encountered among patients presenting to the Emergency Department with complaint...
Tactical Medicine News
ALiEMU AIR Peripheral Vascular Disease Module
Welcome to the Peripheral Vascular Disease (PVD) Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media In...
Tactical Medicine News
Chest Pain and Making the Most of Observation: ACEP-EQUAL Network Podcast
Emergency Medicine has made significant contributions to the proliferation of Observation Medicine, an attractive alternative to admission for pati...
Tactical Medicine News
Bacterial Endocarditis
Background:
Definition
Infective Endocarditis (IE) = Inflammation of the endothelium of the heart, heart valves (or both) (Osman 2013)
Epide...
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
The Post-ROSC Checklist: Standardizing Clinical Practices
In emergency medicine, we are so heavily trained in resuscitation that any senior resident could recite the ACLS algorithm to you after being woken...
Tactical Medicine News
ALiEMU Capsules Module 8: Venous Thromboembolism
We are proud to present Capsules Module 8: Venous Thromboembolism, now published on ALiEMU. Here is a summary of the key points from this outstandi...
Tactical Medicine News
Ultrasound For The Win! Case – 40F with Fever, Chest Pain, Shortness of Breath
Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real clini...
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
Magnesium for Rapid Atrial Fibrillation Rate-Control in the ED
We love magnesium in the Emergency Department. It’s been said that magnesium is second-line for everything (kind of like doxycycline). But what abo...
Tactical Medicine News
Diagnose on Sight: Swollen Leg
Case: A 58 year-old female presents with a one-day history of worsening right lower extremity pain and swelling, and an acute onset of dyspnea. Her...
Tactical Medicine News
Trick of the Trade: Ultrasound for Pedal Pulse Identification and ABI
The Problem: A patient is rolled in to your ED by EMS with extremity trauma. You’re rightfully concerned about possible vascular injury to an upper...
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