ER venous panel or BMP?

You have a patient who is in acute renal failure. You have sent an ER-venous panel that shows a Cr of 4.6, a BUN of 95, and a K of 6.5. You discuss these findings with your nephrology colleagues who request you get the “more accurate” basic metabolic panel. But is it?   Answer: ItRead more


74 yo F with hx of CAD, afib, HLD, severe LV dysfunction is brought in by EMS as a notification for a STEMI. A 12-lead EKG in your ED shows the same as the EMS EKG. Should you activate the CATH lab?   Answer: Check an old EKG. An old EKG 3 months before showedRead more

Topical antibiotics after suture repair?

So, you’ve just finished suturing an uncomplicated laceration and you think to yourself: should I apply antibiotic ointment or just cover with a bandage with good return precautions?   Answer: There is some limited evidence to support antibiotic ointment use.   A study by Dire et al. in 1995 enrolled 465 patients with uncomplicated EDRead more

The 52 in 52 Review: A Comparison of Coronary Angioplasty to Fibrinolytic Therapy in Acute Myocardial Infarction (Do I lyse or do I transfer?)

Article Citation: Andersen HR, Nielsen TT, Rasmussen K, Thuesen L, et al; DANAMI-2 Investigators. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003 Aug 21;349(8):733-42. PMID: 12930925   What we already know about the topic:  Globally, ischemic heart disease is the leading cause of death amongst adults. TheRead more

Is there anyway to differentiate between a traumatic tap and an aneurysmal SAH?

There may be.     Traumatic lumbar punctures occur in up to 30% of lumbar punctures. An observational, multicenter cohort study by Jeffrey Perry et. al. attempted to answer this question and enrolled sequential patients with acute non-traumatic headaches who: had a GCS of 15, were neurologically intact, and whose headache reached a peak intensityRead more

SVT in a pediatric patient? Try chilling them out with some ice.

A 3 week old male, born NSVD 40w6d, presents to the ED with 2 days of feeding intolerance. Initial vitals show a heart rate of 260, bp 83/51, RR 40, sat 100% RA, temp 37C. You quickly get an EKG pictured below that shows a regular, narrow complex tachycardia consistent with SVT. What is your nextRead more

Posterior Lateral Maleolus, My Old Friend

Source: See citation below Pearl:  When applying the Ottawa Ankle Rule, we specifically palpate the posterior maleoli. Explanation: When reviewing the Ottawa Ankle Rule today during morning report the question came up: why do we specifically palpate the posterior lateral and medial maleoli to assess for bony tenderness? The image above, from the initial derivation study andRead more

The 52 in 52 Review: CT Before LP?

Note: Some of the junior residents are unaware of what the 52 in 52 Review is. In brief. The ALIEM blog picked a list of 52 influential papers in EM (we are on version 2 now) to provide a weekly reading topic. The full list is available here. Article Citation: Hasbun R, Abrahams J, Jekel J, QuagliarelloRead more

Esmolol for Refractory VFib

By Jer5150 – Own work, CC BY-SA 3.0, Pearl: In cardiac arrest, consider esmolol (500mcg/kg loading dose, then 0-100mcg/kg/min drip) for refractory ventricular fibrillation. Background: Ventricular fibrillation is one of our two “shockable” rhythms and is supposed to portend a better cardiac arrest outcome. But what if your patient is refractory to standard treatmentRead more

Very Expensive Stickers

My Hospital computer would not permit an image pertinent to this post to be downloaded without admin privileges, so here is a photo of Quinoa. Pearl: Lidoderm 4% patches are available over the counter. Lidoderm 5% patches are prescription only. Background: There are decent data that for certain indications (post-herpetic neuralgia, neuropathic pain) that topicalRead more