Ketamine PSA with Desaturation

During a busy day in the ED, it becomes apparent that the pulling and yanking on your patient’s shoulder has done absolutely nothing to reduce their shoulder. You perform your pre-procedure PSA Checklist, know that this young and active 18 year old poses little difficulty, and push your desired dose of ketamine. Suddenly, you notice theRead more

Sinusitis In Pediatrics?

You’re working in pediatrics, when a mother comes in stating her 5 year old has sinusitis. He presents with fever, cough, runny nose, and some discomfort over where his frontal sinuses are. Does he have sinusitis? Not so fast! The ethmoid and maxillary sinuses develop during gestation, and are therefore present at birth. The sphenoidRead more

Ring Removal

Over the past week, we’ve had a strange uptick in number of patients presenting to the ER with rings stuck on their finger. This is a quick review on the options that you have regarding how to remove them. Assuming your patient has tried soaking their hand, and tried soap to remove it, there areRead more

TPA For Minor Stroke?

  So, you’re working in the ED when a new stroke code is activated. You walk over and see a young gentleman with the complaint of left facial tingling, right arm and leg weakness with some tingling. Overall though, a relatively well looking person with mild deficits. Neurology gets there, the patient is whisked offRead more

Central Line Wizardry

I was scrolling through twitter this morning when I came across a quick video from @CriticalCareNow for an awesome central line trick. And then I went to his feed and found some more. They are pretty genius and I think I’ll start using a few. Check out Dr. Haney Mallemat’s twitter at @CriticalCareNow for videoRead more

Let’s wait for the “official urinalysis”….?

Chances are you order a urine dip or urinalysis on a good number of your patients each shift. But how good are these tests at helping us diagnose a urinary tract infection? The short answer: not fantastic. Let’s continue, focusing on the “official UA”.  When looking at the UA results to determine if a patientRead more

National Physician Suicide Awareness Day

This past Tuesday (September 17th) was the first annual National Physician Suicide Awareness Day. CORD, ACEP, SAEM and a number of other EM organizations paired with organization from other specialties to raise awareness of the epidemic. It’s an effort to break down the stigma surrounding mental health, open the conversation to make change, and toRead more

M is for morphine

Remember MONA (morphine, oxygen, nitro, aspirin) from med school? Well, she may be just “A” now…. Over the years, all of these treatments (except for good old aspirin) have become somewhat controversial in the treatment of ACS. Let’s focus on morphine today. Morphine’s obvious benefit is its ability to control pain and therefore decrease sympatheticRead more

Meningitis Prophylaxis

Have you ever taken care of really critical, undifferentiated patient, only later to find out that they were diagnosed with a serious, contagious illness? We are exposed to innumerable pathogens each day in the ED, but there are only a few that necessitate antimicrobial prophylaxis and even fewer that require prophylaxis from simply being veryRead more

The Betel Nut: an oral carcinogen

Ever walk up to a stable, comfortable appearing patient at Elmhurst and their mouth/teeth are completely RED? Or maybe like a dark brownish/black color? Like this?? It really scared me the first I saw it as an intern. I must have asked her 100 times if she was vomiting blood. But the patient said sheRead more