Balanced Crystalloids versus Saline in Noncritically Ill Adults WH Self et al. New England Journal of Medicine, March 2018. [paper] Why I chose this article This article is another flashpoint in the long debate – typically between internists and surgeons – regarding the use of normal saline versus balanced crystalloids for resuscitation. I remember being
In Memory On November 19th, 2018 the BrownCoat family lost one of our own, Dr. Tamara O’Neal, in a horrific act of violence that also took the lives of three others: police officer Samuel Jimenez, pharmacy resident Dayna Less, and the perpetrator of the shooting. We grieve and remember a life so bright and taken
What is a Browncoat After years of undergraduate education, followed with more years of medical school, I had matched in my top choice emergency medicine residency program. It was the last of twenty-two interviews I had been on. I received the invitation on just a few days’ notice but I went anyway. I had no
Key High-Efficiency Practices of Emergency Department Providers: a Mixed-Methods Study. Morgan R. Bobb et al. Society for Academic Emergency Medicine, Dec 2017. [paper] Why I chose this study Efficiency matters, and not just for the physician. Efficiency has a profound impact on patient care and patient outcomes. We all have heard of (or perhaps have
We continue the series with Knowledge Bomb #20. The purpose and motivation for this series is outlined in the first entry and extensively in an ALiEM IDEA series blog entry. Background Cerebral edema is one of the most feared complications in pediatric patients with diabetic ketoacidosis (DKA). It is the leading cause of death from this disease process. Thankfully
Association Between Therapeutic Hypothermia and Survival After In-Hospital Cardiac Arrest. Chan, Paul et al. JAMA. Oct 2016. [paper] Why I chose this study I recently rotated through the ICU and experienced multiple in-hospital cardiac arrests. There is research that suggests therapeutic hypothermia improves outcomes for out-of-hospital cardiac arrest. We were cooling patients with in-hospital cardiac arrest
We continue the series with Knowledge Bomb #19. The purpose and motivation for this series is outlined in the first entry and extensively in an ALiEM IDEA series blog entry. Background Dyspnea and acute respiratory failure are among the top 5 reasons for patients to present to the Emergency Department. High-velocity nasal insufflation (HVNI), a type of high-flow nasal
Heart Failure for the Resuscitationist: The Basics I don’t have to tell you that heart failure is a common condition in the general population and in patients presenting to the emergency department (ED). We see it on a daily basis. Even with this familiarity there are still some conundrums in the care of these patients.
Preoxygenation With Flush Rate Oxygen: Comparing the Nonrebreather Mask With the Bag-Valve Mask Driver, Brian E et al. Annals of Emergency Medicine, March 2018. [paper] Why I chose this study While preoxygenating during rapid sequence intubation for spontaneously breathing patients, I’ve typically used bag valve mask (BVM) and nonrebreather mask (NRB) interchangeably. This is mainly based
We continue the series with Knowledge Bomb #18. The purpose and motivation for this series is outlined in the first entry and extensively in an ALiEM IDEA series blog entry. Background It’s a busy ER shift. Everyone seems pretty sick today. You get a patient into a back room of your emergency department with a pretty bad nosebleed. The
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