The Weather Outside is Frightful

With the arctic blast sweeping through the country, the incidence of patients with severe hypothermia is likely to increase. So what do you do when you’re sitting in the cardiac room and EMS brings in a patient with a very low core temp? Lets review the techniques of rewarming that should be in your arsenal.Read more

Weathering the Storm

You’re in the resus room having your morning bottle of water when the triage nurse rolls in your new patient. Diaphoretic, talking but lethargic appearing, and, when placed on the monitor, showing this: Being the astute resident that you are, you know this is VT and the next step is cardioversion in an unstable patientRead more

Getting the Finger

Hand pain: a chief complaint that can be seen at any level of emergency medicine. But do you know what to do if your patient has finger trauma involving the nail and happen to be in a place without a hand service to consult your troubles away? Say you see your patient who had aRead more

Tis the Season!

Its a holiday weekend. The decorations are up. Presents will soon be unwrapped. A beautiful tree is decorated and lit. But did you know your living room of festivity can be a death trap in the making? For example, the beautiful holly on the window sill, if ingested, has a toxin named saponin which canRead more

Less is more?

You’re halfway through your pediatric overnight shift and you have a 15 yr old come in brought in by his parents. You see him with his head turned all the way to the right and in some amount of pain. You open up his chart and note multiple psych encounters and a med list showingRead more

You moving, bro?

We’ve all been there. The patient in respiratory distress (or any other reason) that you’ve now decided needs an intubation. You’re all set up, you’ve done your checklist, you’ve done your time out, and the meds have gone in. You wait till you think the meds have probably worked and slide the blade into theRead more

Anticoagulation in Pregnancy: What to do about that PE?

It’s early medical school teaching that pregnancy puts a patient at increased risk for thrombotic diseases like DVT and PE, but what can you do when you actually find one? Classic teaching and a quick poll of our residency (n=4) has everyone saying “Coumadin-no, heparin-yes.” While accurate and relatively well studied, it leaves out aRead more

Flomax for Ureteral Stones?

Using Flomax for ureteral stones has been a controversial topic. A meta-analysis of 8 randomized controlled trials consisted of 1,384 patients showed that there was no benefit in giving Flomax to those with ureteral stones < 5mm. However, Flomax was beneficial for patients with stones > 5mm (risk difference=22%; 95% confidence interval 12% to 33%;Read more

Intranasal Fentanyl

Delivering adequate analgesia in pediatric patients in a timely fashion is difficult. IV route requires staffing and produces additional pain and anxiety in this population. However, the oral route has a delayed onset. The benefit to IN fentanyl is that it can provide adequate control pain without IV access. Even if the patient still needsRead more

Etomidate vs. Ketamine

Both etomidate and ketamine are commonly used as the induction agent for RSI in adult trauma patients. There are concerns about etomidate-associated adrenal suppression leading to complications in critically ill patients. This is a retrospective study comparing the outcome of patients intubated in the ED with etomidate vs. ketamine. There were a total of 968Read more