“Tamiflu: A Nice Little Earner”

This post is meant to be an update to yesterday’s post on the CDC recommendations regarding Tamiflu.  Most of this information will be based off of a 2014 Cochrane Review. Toward the end of this post I will delve into the controversial story of how Roche turned Tamiflu into a household name, and netted theRead more


There is a lot of controversy surrounding the use and efficacy of Tamiflu. Below is a brief review of Tamiflu per the CDC.   TL;DR -Likely some benefit in elderly (>65y/o), young (<2 y/o), chronically ill, or hospitalized patients   Benefits -Shorten duration of fever, illness symptoms -May reduce complications from influenza (OM, PNA, respiratoryRead more

Easier Subclavian Access

We don’t often put in subclavian TLCs in the ED because of the increased risk of complications, specifically pneumothorax. Often, it’s difficult to do with US guidance so we turn to placing IJ TLCs instead. However, there are certain patients who might require a subclavian line and in those, anything that makes the subclavian moreRead more

ED Treatment of “Complex” Atrial Fibrillation

Case You receive RESUS signout on a 60F DMII, HTN here with urosepsis s/p abx, lactate downtrending, BPs holding in the 90s-low 100s systolic with IVF. Only thing left to do is talk to the MICU. You note the patient to be in persistent afib with HR 130-150, no h/o afib. When you call theRead more


Should patient with severe sepsis receive steroids? Multiple trials have evaluated this question with varying results The ADRENAL Trial sheds some light on this question. The answer: Probably not   TLDR: Does hydrocortisone reduce mortality among patients with septic shock? 3800 ventilated patient’s with septic shock were randomized to receive 200mg of hydrocortisone or placeboRead more

In-Flight Emergencies

Today’s TR Pearl was inspired by an actual in-flight emergency i helped out with last year. The Case You’re on a flight home from vacation, finally fell asleep only to be woken up by your girlfriend: “Wake up, that passenger is having a seizure.” You look across the aisle and just your luck YouRead more

The Cat’s Out of the Bag

Noninvasive cardiac testing comes in multiple forms. There is the dobutamine or exercise stress echocardiography (DSE/ExSE), myocardial perfusion scintigraphy (MPS)–single photon emission computed tomography (SPECT), and cardiac magnetic resonance imaging (CMR). There is also a growing imaging technique CTA coronary studies which have come about due to the advances in CT technology allowing for fasterRead more

The Nerve!

You’re in your Intake/Fast Track shift and you see a 94 year old patient who had a trip and fall earlier today and now has elbow pain. The elbow is tender and xray shows a fracture dislocation. You call your local ortho and they want to do a closed reduction in the ED, but youRead more

Bite Me, Part Deux

So you’re working your pediatric shift again and you see a child who fell and hit his chin on a table and now has a tongue laceration which you’ve deemed needs repair (see prior post for criteria). How are you going to anesthetize the area in order to get the most comfortable procedure possible? BelowRead more

Cutting the Neck

You’re in a small community ED and the only overnight doctor and you’ve found yourself with a difficult airway. Direct laryngoscopy has failed, video didn’t get a great view, bougie was surprisingly unhelpful, your LMA isn’t the best, and now you’ve reached a point where you know you need a surgical airway. But you hesitate.Read more