Succinylcholine in Myasthenia Gravis

Case: 45yoF with myasthenia gravis presents in respiratory distress.  She requires urgent intubation.  Which paralytic will you use?  Myasthenia gravis is an autoimmune neuromuscular disorder in which antibodies target nicotinic acetylcholine receptors at the neuromuscular endplate, preventing excitation/depolarization and subsequent muscle contraction. Respiratory compromise or failure may occur due to weakening of diaphragm/accessory muscles.  InRead more


Case: You are working in the resus room, when a 65yoM h/o CAD, severe aortic stenosis, dilated cardiomyopathy (EF 15%), presents short of breath in extremis. VS: 75/60, HR 119 RR 24, T98.0, Sp02 94% on NRB He has rales to the apices of the lungs bilaterally. Loud systolic murmur radiating to his carotids. HeRead more

August Q-tips

Patients with lower quadrant pain should typically have gonadal examinations. There are relative exceptions–such as virginal women without history of pelvic examinations or IBD patients with symptoms very typical of previous IBD flairs–but gonadal examinations should still be considered in these patients. Ideally, these examinations should take place before CT imaging.   Patients with previousRead more

Spilled Teacup

A 28 yoM comes in with hand pain after falling on an outstretched hand. His xray is as follows.   What is the diagnosis?Read more

Physical Exam in Septic Arthritis

CASE: 40yoM no PMHX with a swollen, painful right hip joint.  Worsening x5 days. No history of prior episodes, no other joints involved, no fever, no trauma, no GU symptoms, no rash, no vision changes, no IVDU. On exam, pt is afebrile, nontoxic appearing. The hip is warm. You are able to range his hip,Read more

Ultrasound Manual- Japanese Translation

The second edition of the Manual of Emergency and Critical Care Ultrasound is now available in a Japanese language edition. The book, by Vicki Noble and Bret Nelson, has already been translated into Russian, French and Polish. However, there are still English versions available!Read more

Meconium Staining

26 yoF 36 weeks by dates presents to the ED in labor, and has a precipitous birth in the resus area.  The infant is covered with a greenish liquid the consistency of split-pea soup. How do you address this?Read more

Tip of the hat to Dr. Blaivas who forwarded the link to this free OB GYN ultrasound ebook. The book is a PDF download.  The authors also maintain a fairly extensive YouTube Channel that is worth a look. PhilRead more

Ddavp for Hemorrhage in Esrd Patients

CASE: 45F h/o ESRD on dialysis presents ped struck. Pt is obtunded, intubated for airway protection. CT head shows subdural hematoma with midline shift. Neurosurgery is activated. No antiplatelets or anticoagulants. Is this person coagulopathic simply by having ESRD? If so, should we address it with any particular medication?Read more

Bp Goal in Intracerebral Hemorrhage

55 yoF h/o HTN presents BIBEMS with acute onset decreased level of consciousness, onset 3 hours prior to arrival. BP 220/140 HR 50 T 98.0 RR 10 SPO2 92%. Pt is obtunded, no localizing neuro findings. Pt intubated for airway protection. CT shows 30ml intracerebral hemorrhage.   What are your management goals for blood pressure?Read more