Alright, alright, alright: Arrhythmogenic Right Ventricular Cardiomyopathy

When you examine the ECG of a patient who syncopized, what are you looking for? You’re probably checking for a prolonged QT interval, signs of left ventricular hypertrophy consistent with hypertrophic obstructive cardiomyopathy, a delta wave consistent with Wolff-Parkinson-White syndrome, and T-waves suggestive of Brugada syndrome. But is arrhythmogenic right ventricular cardiomyopathy (ARVC) on yourRead more

Opioid Prescriptions in the ED: How Many People Have You Hooked?

To call opioid use in the US a “problem” is a gross understatement, and most of us in Emergency Medicine appreciate this. You may believe that if you only prescribe a small number of pills to an opioid-naïve patient who is truly in pain, you are not causing harm. A new study in the NewRead more

Topical Toxicology: VX Gas and Kim Jong-nam

*Thanks to Dr. Clark Owyang for following this “case” with me!   On February 13, Kim Jong-un, son of Kim Jong-il and half-brother of current North Korean leader Kim Jong-un, was poisoned at Kuala Lumpur airport in Malaysia. He died shortly after. Yesterday, the Malaysian police reported that Kim Jong-nam died of exposure to VXRead more

The 52 in 52 Review: Steroids for Bacterial Meningitis

De Gans J, Van de Beek, D. Dexamethasone in adults with bacterial meningitis. New Engl J Med. 2002;347(20):1549-56.   What we already know about the topic: Bacterial meningitis is a dangerous condition with significant associated morbidity and mortality. Survivors often suffer neurologic sequelae. Bacterial meningitis frequently affects people who were previously healthy and high-functioning.  Read more

Singin’ the blues: What can you do with methylene blue?

Methylene blue (MB) is a heterocyclic aromatic compound, and a basic thiazine dye. We all know that it is used to treat methemoglobinemia. MB is an oxidizing agent, which becomes a reducing agent when NADPH reduces it to leukomethylene blue. It then reduces the iron in methemoglobin, changing it from the ferric (Fe3+) state backRead more

Keeping Myxedema Coma in the Mix: Is Hypothyroidism in Your Differential?

Myxedema coma, or severe hypothyroidism, is an emergent condition with a high mortality rate (30-60%). Our patients rely on us to catch it early and treat aggressively. About 90% of cases occur during the winter months, and it is rarely seen in patients younger than 60.   Causes: Myxedema coma is usually precipitated by anotherRead more

Clot or not: What are we going to do about PESIT?

In October 2016, the Pulmonary Embolism in Syncope Italian Trial (PESIT) was published in the New England Journal of Medicine. Since its publication, it has generated a great deal of conversation and controversy.   First, a brief rundown of the study: Its objective was to determine the prevalence of PE among patients older than 18Read more

The 52 in 52 Review: Hyperbaric Oxygen for Acute Carbon Monoxide Poisoning

Weaver LK, Hopkins RO, Chan KJ, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med. 2002 Oct 3;347(14):1057-67.   What we already know about the topic: Carbon monoxide poisoning is responsible for about 40,000 visits to emergency departments every year in the U.S. Patients who survive the initial insult are vulnerableRead more

Trach It ‘Til You Make It: Types of Tracheostomy Tubes

When we call our colleagues from ENT with a question about a patient’s tracheostomy, they’ll want to know what type of tube the patient has. Let’s go over two types:   Plastic Tubes Flexible plastic tubes (most common brand name is Shiley) are seen very commonly. They usually have an inner cannula and an outerRead more

Electric Feel

What happens when a patient’s pacemaker seems to be malfunctioning? “Call the EP fellow” should not be your only answer! Take a look at the ECG, and ask yourself if the pacemaker may be over-sensing, under-sensing, or failing to capture.   Over-sensing: The pacemaker is too sensitive. It interprets electric potentials that don’t come fromRead more