A Case for Shared Decision Making: CT Angiography vs LP for Subarachnoid Hemorrhage

Scenario: The images from your patient’s non-contrast head CT are finally uploaded and it looks negative. Unfortunately, your patient has been having severe symptoms for almost 24 hours and you know this single study is not sensitive enough to rule-out a SAH. Have you ever informed your patient about the need for LP and haveRead more

Double Sequential Defibrillation for Refractory Vfib

In honor of 5/20/16, a day in which the Sinai ED managed three cardiac arrest patients in less than one hour, I wanted to post a pearl relevant to one of the cases we saw. Our initial goal during a Vfib arrest resuscitation is to optimize uninterrupted compressions and deliver a shock as soon asRead more

Zika: What We Know & What We Don’t

The WHO declared a Public Health Emergency of International Concern on February 1st, 2016 due to the outbreak of microcephaly and Guillain-Barre Syndrome cases associated with the Zika virus. Here’s a quick review of what we do and don’t know: Where is it? Outbreaks have been seen in Southeast Asia, Africa, and the Pacific Islands.Read more

Narcan for the road?

     I could bullet point plenty of statistics, but I don’t think I have to convince you: there is an opioid epidemic and it is getting worse.       We all have treated patients for opioid overdose in the ED. We also frequently identify substance abusers who are at high risk for futureRead more

Just a simple guaiac test….but what makes it tick?

Lets be honest: whether you like it or not, it’s a rare day working in the ED when you don’t guaiac someone. To “guaiac them” is of course slang for performing a point of care fecal occult blood test. Its a valuable tool and can yield useful clinical information when used appropriately. But do youRead more

A V-Tach of Another Color

Here’s an EKG you may never have seen before.  Only slightly frightening, right?  The rate is tachycardic and the width of the QRS tells you that it is coming from below the AV node.  The defining feature here is that the QRS complex alternates from left to right axis between beats.  This EKG is a rare rhythmRead more

Know Your A-Lines (Part 2)

Once you understand the basic functions of the components of your arterial line set-up and know how to position it properly the next level of mastery involves spotting other errors and optimizing them. If you notice that your pulse pressure is very wide your patient may be severely volume depleted, they may have profound aorticRead more

Know your A-lines!

Arterial lines can provide accurate, real-time information on your patient’s blood pressure.  They can be vital in cases where you want to trend precise blood pressure goals or where BP cuffs are producing incongruous measurements in a critically ill patient.  However, as with all tools the information they yield is only as good as the assayRead more