EM/IM Sessions

EM/IM Sessions: POCUS in Undifferentiated Hypotension

Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With Undifferentiated Hypotension? An International Randomized Controlled Trial From the SHoC-ED Investigators Atkinson et al. Annals of Emergency Medicine. October 2018. [paper] Why I Chose This Study In my brief time as a physician I have blindly accepted point-of-care ultrasonography (POCUS) as a useful tool

EM/IM Sessions

EM/IM Sessions: Effect of Occupancy on Critically Ill Admissions

Effect of Emergency Department and ICU Occupancy on Admission Decisions and Outcomes for Critically Ill Patients Kusum S. Mathews et al. Critical Care Medicine. May 2018. [paper] Why I Chose This Study “We have no beds, the MICU is now down to our crash bed” It seems all too frequent that we hear those dreaded

EM/IM Sessions

EM/IM Sessions: HFNC for Bronchiolitis

A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis Franklin, Donna, et al. The New England Journal of Medicine, March 2018. [paper] Why I Chose this Study During my recent PICU and Pediatric ED rotation, a large amount of my patients with bronchiolitis were started on HFNC liberally. Other hospitals that we rotate

EM/IM Sessions

EM/IM Sessions: SALT-ED Trial

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

Knowledge Bomb

Knowledge Bomb: Route of Diltiazem in Afib with RVR

We continue the series with Knowledge Bomb #21. The purpose and motivation for this series is outlined in the first entry and extensively in an ALiEM IDEA series blog entry. Background Atrial fibrillation (afib) with rapid ventricular rate (RVR) can lead to adverse effects on cardiovascular hemodynamics. Sustained elevated rates of disorganized atrial electrical activity leads to the absence

EM/IM Sessions

EM/IM Sessions: ED Efficiency

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

EM/IM Sessions

EM/IM Sessions: Hypothermia for In-Hospital Cardiac Arrest

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


Keeping the Beat

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.

EM/IM Sessions

EM/IM Sessions: Preoxygenation with Flush Rate O2

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

EM/IM Sessions

EM/IM Sessions: Coronary CTA vs Stress Testing

Coronary Computed Tomography Angiography vs Functional Stress Testing for Patients with Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis Foy, Andrew J, et al.  JAMA Internal Medicine 2017. [paper] Why I chose this study Everything is still new and shiny as an intern, even acute chest pain. If the story is good and the