The oft forgotten ‘centesis

Inspired by Dr. Schuberg’s outstanding procedural skillz this week, I present the thoracentesis: Indications: Suspected pleural space infection, new effusion without diagnosis, and relief of dyspnea caused by large effusion Contraindications: severe clotting abnormality (relative) Complications: Ptx, cough, infection, hemothorax, re-expansion pulmonary edema, air embolism. Technique: No specific technique has been shown to be superiorRead more

Doc, I got the sugars, I cannot go home? Or can I…

Before answering that question, I need to acknowledge EM topics ( for bringing this important article to my attention since this is nearly a daily occurrence in our ED. So, do you need to lower blood sugar to a magical, non-evidenced based threshold prior to discharge? Like everything, the answer is…. It depends, but inRead more

Tachypnea, Bradypnea, platypnea and orthodeoxia. Oh my! Wait what?

We are all too familiar with tachypnic and the occasional bradypnic patient (i.e. narcan deficient) rolling through resus, but rarely do we come across platypnic and orthodeoxic (except for yesterday). In order to come across them, you need to know what they are, so here we go. Platypnea is defined as dyspnea in the uprightRead more

Is that really necessary? Pretreatment for RSI

Intubating a patient with a suspected head bleed is one of the highest risk situations we encounter as ED physicians. A failed attempt with enough airway manipulation can potentially increase ICP and have profound negative effects on patient outcomes. EM dogma, perhaps antiquated, dictates pretreatment with an opiate, typically fentayl, and lidocaine. But is theRead more


If yesterday’s post on Roids didn’t get you jack’d then maybe today’s will! Here’s part deuce – Topical Steroids Spoiler alert – if you are using 1% hydrocortisone for every rash everywhere then you are likely underdosing! Dope up your knowledge with this killer chart. [pdf-embedder url=””] References: Ference JD, Last AR. Choosing topical corticosteroids. Am Fam Physician. 2009 Jan 15;79(2): 135-40.Read more


Summer’s here! Time to hit the gym and review your steroid-knowledge. What’s the difference between prednisone/prednisolone/methyprednisolone again?  Well, I’ll give you a hint… its not a pre/post work out fix! Check out this chart below for a quick review. [pdf-embedder url=””] References: Tintinalli’s 7 edition, Chapter 132  Read more

Lumbar Puncture Pearls

Lumbar punctures (LPs) can be tricky even for an experienced provider. Here are some pro tips to help you look like an all-star! Set up: The LP tray contains only a small amount of  lidocaine (~3mls). If you need to make a second attempt in another intervertebral space you may not have enough remaining anesthetic. BringRead more

Kids eat the darndest things!

Did you know you can use a regular old metal detector to rule-in a metallic swallowed foreign body in children? It’s true! Several studies have been published in The Journal of Accident and Emergency Medicine out of  The Royal Hospital for Children located in Glasgow, Scotland. In one large prospective study,  186 children presented to the EDRead more