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SAEM Clinical Images Series: ‘Tis Not the Season to be Wheezing
by Jane Rivas, MD
Nov 21, 2022
A 2-year-old male with a history of solitary kidney presented with greater than one month of daily coughing, wheezing, and decreased appetite. The ...
Tactical Medicine News
SAEM Clinical Images Series: Found Down
A 67-year-old caucasian male experiencing homelessness was “found down” in a parking lot. EMS reported that he had a GCS of 6 with a systolic blood...
Tactical Medicine News
SAEM Clinical Image Series: An Uncommon Cause of Shortness of Breath
A 102-year-old female presents with intermittent epigastric abdominal pain for the last two days. Episodes have no relieving or exacerbating factor...
Tactical Medicine News
High-Dose Nitroglycerin for Sympathetic Crashing Acute Pulmonary Edema
Background Nitroglycerin (NTG) is an important intervention to consider for patients with Sympathetic Crashing Acute Pulmonary Edema (SCAPE) as it ...
Tactical Medicine News
SAEM Clinical Image Series: Shortness of Breath
A 60-year-old female presented to the emergency department (ED) for respiratory distress. Emergency medical services reports that the patient was...
Tactical Medicine News
Is it a Pneumothorax? An Unusual Post-Thoracentesis Radiograph
A 51-year-old female with a history of metastatic ovarian cancer on chemotherapy, malignant pleural effusions requiring repeat thoracentesis, an...
Tactical Medicine News
PEM Pearls: Chest Radiographs for Shortness of Breath
Figure 1: Photo by Tim Bish on Unsplash
Paramedics bring in a 5-month-old boy in respiratory distress. He’s crying furiously and has normal tone...
Tactical Medicine News
ALiEM AIR | Respiratory 2019 Module
Welcome to the AIR Respiratory Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM ...
Tactical Medicine News
SAEM Clinical Image Series: Chest Wall Mass
A 71 year-old patient with a past medical history of hypertension, percutaneous transluminal coronary angioplasty 7 years ago, and robotic corona...
Tactical Medicine News
PEM Pearls: 5 Tips to Demystify Amoxicillin in Pediatric Infections
Amoxicillin is a penicillin derivative antibiotic against susceptible gram positive and gram negative bacteria. It has reasonable coverage for ...
Tactical Medicine News
SAEM Clinical Image Series: Dysphagia and Dyspnea in a Well Digger
[Click for larger view]
Chief Complaint: Pain with swallowing
History of Present Illness: A 43-year-old male presented to the emergency depart...
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
TXA for Everyone: Inhaled TXA for Hemoptysis
Background: Use of tranexamic acid (TXA), an antifibronlytic medication, has certainly become popular for numerous indications (i.e. trauma, uteri...
Tactical Medicine News
D-Dimer in Pregnancy: Limiting Radiation with Pre-test Probability
Background: Pulmonary embolism is the leading cause of death in pregnancy and the puerperium – accounting for nearly 20% of maternal deaths in the ...
Tactical Medicine News
Classic Journal Review – Wells + Dimer to Rule Out PE
EM Journal Update: Safety of Using Wells’ Clinical Model With D-Dimer To Manage Patients In The ED With Suspected Pulmonary Embolism
Background: I...
Tactical Medicine News
Simplifying Mechanical Ventilation – Part 6 – Choosing Your Initial Settings
Choosing Your Initial Settings: I hope you now see what physiologies to consider when setting up the ventilator and your goals for each. If your pa...
Tactical Medicine News
High Flow Nasal Cannula (HFNC) – Part 2: Adult & Pediatric Indications
The use of heated and humidified high flow nasal cannula has become increasing popular in the treatment of patients with acute respiratory failure ...
Tactical Medicine News
High Flow Nasal Cannula (HFNC) – Part 1: How It Works
The use of heated and humidified high flow nasal cannula (HFNC) has become increasingly popular in the treatment of patients with acute respiratory...
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
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
Renal Colic & Pulmonary Embolism CT | Reducing Imaging: ACEP E-QUAL Network Podcast
Computed tomography (CT) is increasingly available across U.S. Emergency Departments and has changed the practice of medicine. However, it is coupl...
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
ALiEMU Capsules Module 9: Hospital Acquired Pneumonia
We are proud to present CAPSULES Module 9: Hospital Acquired Pneumonia (HAP), now published on ALiEMU. Here is a summary of the key points from a s...
Tactical Medicine News
PEM Pearls: 2017 AAP Section of EM’s Guide to Pediatric Community Acquired Pneumonia
Pediatric community-acquired pneumonia (CAP) is an acute, common, and potentially serious infection of the pulmonary parenchyma in children. In Nov...
Tactical Medicine News
AIR Series: Respiratory Module (2017)
Welcome to the Respiratory Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index the ALiEM AIR Team ...
Tactical Medicine News
PV Card: Algorithm for acute bronchiolitis management
Bronchiolitis is a common lower respiratory tract infection in children less than 2 years old, and especially in those 3-6 months old. In a collab...
Tactical Medicine News
AIR Series: Respiratory Part 2 (2015)
We found an enormous amount of respiratory content and thus have divided the respiratory module into two modules. While the first module focused on...
Tactical Medicine News
AIR Series: Respiratory Part 1 (2015)
We found an enormous amount of posts on respiratory topics and thus have divided the content into two modules. This first module will focus on gene...
Tactical Medicine News
Adenosine in reactive airway disease
A 44-year old woman presents via EMS with a chief complaint of a racing heartbeat. She is placed on a cardiac monitor, which displays a heart rate...
Tactical Medicine News
PV Card: Focused Lung Ultrasound
Bedside pulmonary ultrasonography is becoming increasingly popular in the Emergency Department. You can you use it to assess for pneumothoraces, pl...
Tactical Medicine News
ALiEM-Annals of EM Journal Club: Spontaneous pneumothorax, pigtail catheters, and outpatient management
We are very excited this month to bring you another installment of the ALiEM-Annals of EM Global Journal Club. The highlighted article is Voison et...
Tactical Medicine News
Diagnose on Sight: “I feel like I am having a heart attack”
Case: A 18-year-old male with no medical history presents to the emergency department (ED) complaining of “feeling like I am having a heart attack”...
Tactical Medicine News
US4TW Case: 28F with Shortness of Breath
Welcome to the inaugural post for an exciting new ultrasound-based case series called “Ultrasound For The Win!” (#US4TW). In this peer-reviewed cas...
Tactical Medicine News
ADJUST-PE Study: ALiEM-Annals of EM Journal Club
We are very excited this month to bring you our fourth ALiEM-Annals of EM Global Journal Club on the use of age-adjusted D-dimer levels to help exc...
Tactical Medicine News
PEITHO Trial: Fibrinolysis for Intermediate-Risk Pulmonary Embolism
Most of us would agree that massive PE is treated with fibrinolysis and non-massive PE is treated with anticoagulation. The area of great debate h...
Tactical Medicine News
Blood Cultures in Pneumonia
A 75 year old woman is found to have pneumonia. With a CURB-65 of 3 and a PORT score of 95, she is correctly treated her for community acquired pne...
Tactical Medicine News
When the PERC Rule Fails
Kline et al developed a clinical decision tool based on parameters that could be obtained from a brief initial assessment to reasonably exclude the...
Tactical Medicine News
Lactic Acidosis and Beta Agonist Therapy in Asthma
A 45 y/o male with moderate persistent asthma presents with wheezing and cough following a viral URI. He is tachypneic and has diffuse wheezing. PE...
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
Subsegmental Pulmonary Embolisms (SSPE) are Important
Multi-detector computed tomographic pulmonary angiography (CTPA) allows for better visualization of peripheral pulmonary arteries allowing for diag...
Tactical Medicine News
The Not-So-Sick Health-Care Associated Pneumonia Patient: New Treatment Strategy
Health-care associated pneumonia (HCAP) is the term used to describe patients presenting with pneumonia who may be at higher risk of multi-drug re...
Tactical Medicine News
52 Articles in 52 Weeks: Landmark EM Articles 2013
To provide a resource for evidence-based Emergency Medical education, this list of must-read landmark articles was created to supplement the Emerge...
Tactical Medicine News
Acute Pulmonary Embolism: Size does matter and ECG can give us clues
Acute pulmonary embolism (PE) is a common condition that can be both severe and difficult to diagnose. Half of all acute PE cases are diagnosed i...
Tactical Medicine News
Rivaroxaban for Pulmonary Embolism: One pill and done?
With Dr. Jeff Tabas giving a lecture on the perennially hot topic of pulmonary embolism (PE) at the upcoming UCSF High Risk EM Conference (main li...
Tactical Medicine News
Patwari Academy videos: Respiratory failure and ventilators
Dr. Rahul Patwari reviews the basics of respiratory physiology, the pathophysiology behind respiratory failure, and ventilator management. What do...
Tactical Medicine News
Lytics for sub-massive PE: Ready for primetime?
There was recently a great study published in the American Journal of Cardiology (2012) by Sharifi et al1, questioning whether we should be conside...
Tactical Medicine News
PE in pregnancy: which diagnostic tests do you use?
Pulmonary embolism (PE) can be a deadly disease and one of the most challenging diagnosis to make in a pregnant patient. Patients may present with ...
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
MIA 2012: Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012 Mar;59(3):165-75.e1.
Bottom Line 1
Tactical Medicine News
PV card: PE Severity Index (PESI) score
Do you send some of your low-risk patients with pulmonary embolism home?
This is a controversial issue which warrants a look at risk stratificatio...
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