Tick Removal

Yesterday we reviewed how to remove a fish hook. Today we will piggy back off that theme, and because summer is coming, review how to remove a tick.   Aside from Lyme disease, ticks are capable of transmitting multiple diseases, including ehrlichiosis, babesiosis, Rocky Mountain spotted fever, tularemia, and tick paralysis. Early removal of theRead more

Fish Hook Removal

Today’s pearl is courtesy of the sea and (the other) JP: how to remove a fish hook from human flesh. 1. Remove any fish hook flair – ie weights, lines, weird hair looking things, etc. 2. Clean the surrounding skin with betadine. 3. Anesthetize the area. If it is a digit, which is common, perform a digital block.Read more


Today’s pearl is courtesy of North Korea. They claimed that Otto Warmbier, an imprisoned American who unfortunately died a few days after his return to the US, had suffered brain damage after contracting botulism. If you think that sounds wonky, you’re probably right. If you thinks that sounds probable, here is a refresher on botulism,Read more

52 in 52: Canadian Head CT Rule

Stiell IG, Wells GA, Vandemheen K, Clement C, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001 May 5;357(9266):1391-6. PMID: 11356436   What we already know: Prior to this study, there was disagreement and lack of standardization in the use of CT in patients with minor head trauma. Though a numberRead more

Lateral Lumbar Puncture

If you are unsuccessful with an LP, consider ditching the midline angle and instead approaching laterally. The lateral approach allows you to avoid the supraspinous and interspinous ligaments, which are often crunchy and calcified in older patients. Prep the patient the same way you would as the traditional approach. Patients can be in either theRead more

Easy IJ

I was recently helping the resus resident with establishing peripheral IV access in a hemodynamically stable patient who needed to be urgently loaded with keppra. Multiple attempts by myself and 3 other providers were unsuccessful. I couldn’t see an EJ (the patient turned out to be severely dehydrated, which explained the lack of viable veins).Read more

52 in 52: Wait and See Rx in Acute OM

Spiro DM, Tay KY, Arnold DH, Dziura JD, et al. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA. 2006 Sep 13;296(10):1235-41. PMID: 16968847   What we already know: The most common diagnosis for which antibiotics are prescribed in the pediatric population is acute otitis media (AOM). Two previous randomized trialsRead more

Congenital Adrenal Hyperplasia

A 1-week-old infant is brought in by his mother for decreased responsiveness and vomiting. Prenatal and birth history were unremarkable. He is cool, clammy, and lethargic. Nurses are unable to obtain a blood pressure, and he is hypoglycemic to the 30s. You establish IV access, send labs, and administer fluids and dextrose. He then beginsRead more

Paracentesis Checklist

One of the most frequent requests we receive as teaching residents (and probably as senior residents) is assistance with performing paracenteses. By now, all of the EM residents are probably comfortable with this procedure. But, July is coming! With it comes newly minted doctors and off service rotators who are eager to learn. Feel free toRead more

Red Man Syndrome

Today in resus, the nurse told me that one of the patients, a woman being treated with vancomycin, began to appear flushed and kept itching her face. The patient denied respiratory or GI complaints. She denied previous drug allergies, and had received vancomycin in the past without issues. Just like the rapper in the imageRead more